Individual
DR. CLINTON GRAVES WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6516 N OLIE AVE STE A, OKLAHOMA CITY, OK 73116-7399
(405) 486-6960
(405) 486-6961
Mailing address
6516 N OLIE AVE STE A, OKLAHOMA CITY, OK 73116-7399
(405) 486-6960
(405) 486-6961
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
24646
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
.
—
OK
Enumeration date
05/18/2006
Last updated
02/17/2025
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