Organization
BREEDLOVE WOUND CARE OF OKLAHOMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WILSON (ASSISTANT MANAGER CREDENTIALING)
(956) 331-2458
Entity
Organization
Contact information
Practice address
207 E TALIAFERRO ST, MADILL, OK 73446-3410
(903) 947-2020
Mailing address
PO BOX 1129, TATUM, TX 75691-1129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
01/22/2025
Last updated
01/22/2025
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