Individual
WALTER MARK BOOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13313 N MERIDIAN AVE STE D, OKLAHOMA CITY, OK 73120-8316
(405) 755-4290
(405) 755-7773
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(314) 364-4200
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
17300
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090560A
—
OK
Enumeration date
07/12/2006
Last updated
01/14/2026
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