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Organization
MEDICINE WHEEL INC
Active
Organization
MEDICINE WHEEL INC
Active
Other names
Caddo Family Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL E WEATHERS DO (MEDICAL DIRECTOR)
(580) 367-2100
Entity
Organization
Contact information
Practice address
128 BUFFALO STREET, CADDO, OK 74729
(580) 367-2100
(580) 367-2103
Mailing address
PO BOX 146, CADDO, OK 74729-0146
(580) 367-2100
(580) 367-2103
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2982
OK
208D00000X
General Practice Physician
Primary
2982
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200328450A
—
OK
05
—
200328450B
—
OK
Enumeration date
12/18/2012
Last updated
05/20/2014
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