Most Relevant Information
Provider Data
| NPI Number: | 1003466103 |
| Provider Name: | DESHAUN LAMAR MOOTRY |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/19/2019 |
| Last Updated: | 11/10/2020 |
Provider Practice Location
1 W 36TH ST N
TULSA
OK
741061700
Practice Location Phone/Fax
| Phone: | 9184254200 |
| Fax: |
Provider Mailing Location
1 W 36TH ST N
TULSA
OK
741061700
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |