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General NPI Number Information
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NPI Number | 1861205379
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Entity Type | Organization
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Legal Business Name | W PROFESSIONAL SURGICAL SERVICES PLLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 10001 BROADWAY EXT STE A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-6307
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Country | US
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Telephone | 405-748-5950
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Fax | 405-607-3580
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Provider Business Mailing Address
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Address Line | 6608 N WESTERN AVE # 416
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City | NICHOLS HILLS
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State | OK
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Zip | 73116-7326
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Country | US
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Telephone | 405-748-5950
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Fax | 405-607-3580
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Authorized Official
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Title or Position | PHYSICIAN & OWNER
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Name | IVAN WAYNE
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Credential | MD
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Telephone | 405-748-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State |
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