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General NPI Number Information
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NPI Number | 1093833220
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Entity Type | Individual
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Provider Name | MICHAEL CLARK FRETER S.T.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1809 E 13TH ST SUITE #400
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City | TULSA
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State | OK
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Zip | 74104-4419
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Country | US
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Telephone | 918-599-8200
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Fax | 918-583-4678
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Provider Business Mailing Address
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Address Line | 11251 WESTFALL RD
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City | SKIATOOK
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State | OK
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Zip | 74070-5289
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Country | US
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Telephone | 918-396-2468
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | NONE
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License Number State |
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