Most Relevant Information
Provider Data
| NPI Number: | 1003469297 |
| Provider Name: | ELY JAMES BURGESS |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/17/2019 |
| Last Updated: | 08/15/2019 |
Provider Practice Location
401 W. MAIN ST.
BARNSDALL
OK
740026631
Practice Location Phone/Fax
| Phone: | 9188473527 |
| Fax: | 9187779018 |
Provider Mailing Location
401 W. MAIN ST.
BARNSDALL
OK
740026631
Provider Mailing Phone/Fax
| Phone: | 9188473527 |
| Fax: | 9187779018 |