# WALLACE B. MCLEOD III, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wallace B. McLeod III, M.D
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861711731
- **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
- **Mailing address fax:** (405) 424-0115

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 170100000X | Ph.D. Medical Genetics | 15393 | OK | Yes |

## Other

- **Enumeration date:** 05/18/2010
- **Last updated:** 05/18/2010