Individual
TAYLOR WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 697-5072
Mailing address
4308 S ASH AVE, BROKEN ARROW, OK 74011-3602
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/13/2021
Last updated
06/07/2023
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