Healthcare Provider Details

I. General information

NPI: 1336412949
Provider Name (Legal Business Name): WAYNE E. WILLIAMS D.O. P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PORTER
NORMAN OK
73071-6404
US

IV. Provider business mailing address

PO BOX 722788
NORMAN OK
73070-9117
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-1000
  • Fax:
Mailing address:
  • Phone: 405-694-5496
  • Fax: 405-366-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5131
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number5131
License Number StateOK

VIII. Authorized Official

Name: WAYNE E. WILLIAMS
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 918-207-7893