Healthcare Provider Details
I. General information
NPI: 1710170519
Provider Name (Legal Business Name): ALL IS WELL PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
13321 N MERIDIAN AVE STE 200
OKLAHOMA CITY OK
73120-8356
US
IV. Provider business mailing address
13321 N MERIDIAN AVE STE 200
OKLAHOMA CITY OK
73120-8356
US
V. Phone/Fax
- Phone: 405-749-9200
- Fax: 405-749-9210
- Phone: 405-749-9200
- Fax: 405-749-9210
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 16134 |
| License Number State | OK |
VIII. Authorized Official
Name: DR.
GARLANDA
L.
PARKER
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 405-749-9200