Healthcare Provider Details

I. General information

NPI: 1366761108
Provider Name (Legal Business Name): JULIE LOUISE WILEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE LOUISE THOMAS DO

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 NW 9TH ST STE 220
OKLAHOMA CITY OK
73102-1070
US

IV. Provider business mailing address

535 NW 9TH ST STE 220
OKLAHOMA CITY OK
73102-1070
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-8498
  • Fax: 405-272-8425
Mailing address:
  • Phone: 405-272-8498
  • Fax: 405-272-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5123
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: