Healthcare Provider Details

I. General information

NPI: 1669531604
Provider Name (Legal Business Name): WALTER SCOTT WAUGH III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 NW 135TH ST
OKLAHOMA CITY OK
73120-4009
US

IV. Provider business mailing address

3410 NW 135TH ST
OKLAHOMA CITY OK
73120-4009
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-6111
  • Fax: 405-751-0479
Mailing address:
  • Phone: 405-751-6111
  • Fax: 405-751-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25617
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: