Individual
SPENCER DAVID WIDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4908 S SHERIDAN RD, TULSA, OK 74145-5712
(918) 984-9153
Mailing address
1523 E 55TH ST, TULSA, OK 74105-6918
(918) 607-1024
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/26/2020
Last updated
02/26/2020
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