Doctor Name: | BETH LEE LEADER |
NPI Number: | 1891786737 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DO |
License Number: | 2795 |
Business Practice Address: | 603 Ne 2nd St Rowland Flatt Clinic Antlers, OK - 745232636 |
Business Phone Number: | 5802983351 |
Business Fax Number: | 5802983803 |
Mailing Address: | 603 Ne 2nd St, ANTLERS |
State: | OK |
Postal Code: | 745232636 |
Phone Number: | 5802983351 |
Fax Number: | 5802983803 |
NPI Enumeration Date: | 10/31/2005 |
NPI Last Update Date: | 04/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 2795 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |