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General NPI Number Information
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NPI Number | 1407879729
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Entity Type | Organization
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Legal Business Name | OB-GYN CARE OF NORTHWEST OKLAHOMA
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 1024 MAIN ST
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City | WOODWARD
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State | OK
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Zip | 73801-3120
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Country | US
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Telephone | 580-256-6000
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Fax | 580-256-6008
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Provider Business Mailing Address
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Address Line | 1024 MAIN ST
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City | WOODWARD
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State | OK
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Zip | 73801-3120
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Country | US
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Telephone | 580-256-6000
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Fax | 580-256-6008
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. ALAN MARVIN WAGNER
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Credential | M.D.
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Telephone | 580-256-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24684
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License Number State | OK
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