Organization
SOUTHERN OKLAHOMA UROLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN E DIACON JR. MD (PRESIDENT)
(580) 332-0112
Entity
Organization
Contact information
Practice address
1414 ARLINGTON ST, SUITE 2300, ADA, OK 74820-2643
(580) 332-0112
(580) 332-1005
Mailing address
1414 ARLINGTON ST, SUITE 2300, ADA, OK 74820-2643
(580) 332-0112
(580) 332-1005
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
OK
Other
Enumeration date
09/18/2007
Last updated
09/18/2007
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