MEDICARE: DEANA M. WAGES P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1451	OK

General Provider Information

NPI Number	:	1134109457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANA M. WAGES P.A.

Provider Business Mailing Address
First Line	:	2417 COUNTY ROAD 1263 STE 100
Second Line	:
City	:	BLANCHARD
State	:	OK
Zip	:	73010-3123
Country	:	US
Telephone Number	:	405-274-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 COUNTY ROAD 1263 STE 100
Second Line	:
City	:	BLANCHARD
State	:	OK
Zip	:	73010-3123
Country	:	US
Telephone Number	:	405-274-5551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	03/25/2019

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