Individual
BRYON KEITH WADE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 N FAIRLAND ST, PRYOR, OK 74361-4205
(918) 625-6128
Mailing address
109 N FAIRLAND ST, PRYOR, OK 74361-4205
(580) 768-1927
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
10/24/2025
Last updated
10/24/2025
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