Individual
DR. CLARENCE L WILEY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,M.M.S.,F.A.A.D
Contact information
Practice address
1211 N SHARTEL AVE STE 407, OKLAHOMA CITY, OK 73103-2425
(405) 278-7911
(405) 278-7925
Mailing address
PO BOX 2074, LOWELL, AR 72745-2074
(405) 278-7911
(405) 278-7925
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
12980
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
243432400
MEDICARE
OK
Enumeration date
08/11/2006
Last updated
08/04/2016
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