Provider Demographics
NPI:1467856153
Name:DEERE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DEERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-0723
Mailing Address - Country:US
Mailing Address - Phone:918-935-1214
Mailing Address - Fax:
Practice Address - Street 1:17713 S SANTE FE PL
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047
Practice Address - Country:US
Practice Address - Phone:918-935-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare