Healthcare Provider Details

I. General information

NPI: 1740207828
Provider Name (Legal Business Name): WESTERN OKLAHOMA RADIOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL DR
GUYMON OK
73942-4438
US

IV. Provider business mailing address

PO BOX 1589
ELK CITY OK
73648-1589
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-6515
  • Fax: 580-225-5423
Mailing address:
  • Phone: 580-225-5406
  • Fax: 580-225-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: ROBERT A WILLIAMS
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 580-225-5403