Individual
IVAN WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10001 BROADWAY EXT STE A, OKLAHOMA CITY, OK 73114-6307
(405) 748-5950
(405) 607-3580
Mailing address
6608 N WESTERN AVE # 416, NICHOLS HILLS, OK 73116-7326
(405) 748-5950
(405) 607-3580
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
22995
OK
207YS0123X
Facial Plastic Surgery Physician
Primary
22995
OK
Other
Enumeration date
03/14/2006
Last updated
01/13/2025
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