# WALLACE B MCLEOD III, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1194044313
- **Authorized official:** MRS. JESSIE MAE SHAMBRA (OFFICE MANAGER)
- **Authorized official phone:** (405) 424-0111

## Contact information

- **Practice address:** 2216 N MARTIN LUTHER KING AVE, OKLAHOMA CITY, OK 73111-2445
- **Practice address phone:** (405) 424-0111
- **Mailing address:** 2216 N MARTIN LUTHER KING AVE, OKLAHOMA CITY, OK 73111-2445
- **Mailing address phone:** (405) 424-0111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2010
- **Last updated:** 10/17/2022