Individual
WALLACE HELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 E TAMARACK RD, STE B, ALTUS, OK 73521-1234
(580) 482-4095
(580) 481-2499
Mailing address
PO BOX 8190, ALTUS, OK 73522-8190
(580) 482-4781
(580) 481-2345
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
22963
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100845290A
—
OK
Enumeration date
06/30/2005
Last updated
04/23/2008
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