Individual
IVANKA A VASSILEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4411 W GORE BLVD, STE B10, LAWTON, OK 73505-5977
(580) 354-9600
(580) 354-9621
Mailing address
4411 W GORE BLVD, STE B10, LAWTON, OK 73505-5977
(580) 354-9600
(580) 354-9621
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22970
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200055900A
—
OK
Enumeration date
09/08/2005
Last updated
02/09/2012
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