# JOHN BELK FAMILY PRACTICE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134655004
- **Authorized official:** JOHN BELK MD (MBR)
- **Authorized official phone:** (580) 647-6594

## Contact information

- **Practice address:** 1103 W CHEROKEE ST, WAGONER, OK 74467-4621
- **Practice address phone:** (580) 647-6594
- **Mailing address:** 1103 W CHEROKEE ST, WAGONER, OK 74467-4621

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 30768 | OK | Yes |

## Other

- **Enumeration date:** 05/11/2017
- **Last updated:** 07/18/2017