ERIC W MIX

MUSKOGEE, OK
NPI1003806704
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: OK  4316)
Additional Taxonomies207PE0004X Emergency Medicine, Emergency Medical Services
(Licence: OK  4316)
Enumeration Date2005-10-24
Last Update Date2009-08-31
Business Address
-- ERIC W MIX DO
300 ROCKEFELLER DR
MUSKOGEE, OK 74401-5075
Phone number: 918-781-9466
Mailing Address
-- ERIC W MIX DO
LOCKBOX #17 2424 E. 21ST #100
TULSA, OK 74114-1711
Phone number: 866-321-8433
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