Healthcare Provider Details

I. General information

NPI: 1699573485
Provider Name (Legal Business Name): MATTHEW BUHR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11982 S MULBERRY CT
JENKS OK
74037-2181
US

IV. Provider business mailing address

311 W 32ND PL
SAND SPRINGS OK
74063-3009
US

V. Phone/Fax

Practice location:
  • Phone: 539-777-0940
  • Fax:
Mailing address:
  • Phone: 918-231-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: