MEDICARE: WALTER JAY EXON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	10770	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558312173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER JAY EXON MD

Provider Business Mailing Address
First Line	:	1145 S UTICA AVE
Second Line	:	SUITE 110
City	:	TULSA
State	:	OK
Zip	:	74104-4000
Country	:	US
Telephone Number	:	918-579-3825
Fax Number	:	918-579-1262

Provider Business Practice Location Address
First Line	:	1245 S UTICA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4214
Country	:	US
Telephone Number	:	918-560-3832
Fax Number	:	918-583-0423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	05/04/2009

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Directions to “ WALTER JAY EXON MD” Practice Location

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