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General NPI Number Information
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NPI Number | 1750913117
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Entity Type | Organization
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Legal Business Name | WONDER KIDS SPECIALTY PEDIATRICS PLLC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 5606 SW LEE BLVD STE 201
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City | LAWTON
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State | OK
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Zip | 73505-9651
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Country | US
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Telephone | 580-368-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 4202 SW LEE BLVD BUILDING B, SUITE 100
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City | LAWTON
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State | OK
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Zip | 73505-8343
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Country | US
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Telephone | 580-368-0808
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA WHITE
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Credential | DO
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Telephone | 580-713-2947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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