Individual
MR. SHRIKRISHNA V VAIDYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 FAIRVIEW, ST 10, PONCA CITY, OK 74601
(580) 762-7734
(580) 762-6914
Mailing address
400 FAIRVIEW ST 10, PONCA CITY, OK 74601
(580) 762-7734
(580) 762-6914
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
16078
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010998
PTAN
KS
05
—
100185320A
—
OK
05
—
100206890B
—
KS
Enumeration date
04/19/2006
Last updated
06/10/2008
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