Healthcare Provider Details

I. General information

NPI: 1467856153
Provider Name (Legal Business Name): DAVID DEERE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17713 S SANTE FE PL
MOUNDS OK
74047
US

IV. Provider business mailing address

PO BOX 723
GLENPOOL OK
74033-0723
US

V. Phone/Fax

Practice location:
  • Phone: 918-935-1214
  • Fax:
Mailing address:
  • Phone: 918-935-1214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: