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General NPI Number Information
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NPI Number | 1750057949
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Entity Type | Individual
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Provider Name | MILES COLEMAN WALLER MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 2226 E 38TH ST
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City | TULSA
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State | OK
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Zip | 74105-3406
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Country | US
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Telephone | 918-671-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 N ROSS AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7016
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Country | US
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Telephone | 918-671-6400
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 45921
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License Number State | OK
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