TIMOTHY BLACKSTAD

TULSA, OK
NPI1396523643
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2023-09-18
Last Update Date2023-09-18
Business Address
TIMOTHY BLACKSTAD DO
1111 W 17TH ST
TULSA, OK 74107-1886
Phone number: 918-582-1972
Mailing Address
TIMOTHY BLACKSTAD DO
4308 W KENT ST
BROKEN ARROW, OK 74012-9419
Phone number: 918-644-9799
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