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General NPI Number Information
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NPI Number | 1306106729
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Entity Type | Individual
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Provider Name | MATTHEW BLAKE WEDMAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 4401 S WESTERN AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-3413
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Country | US
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Telephone | 405-636-7362
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Fax | 405-636-7861
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Provider Business Mailing Address
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Address Line | 3001 QUAIL SPRINGS PKWY FL 5
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-2640
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Country | US
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Telephone | 405-636-7362
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Fax | 405-636-7861
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 29866
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License Number State | OK
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