Individual
DR. STORMY RAY WALKUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1302 S LYNN LN, IDABEL, OK 74745-6860
(580) 286-3993
(580) 286-3967
Mailing address
1302 S LYNN LN, IDABEL, OK 74745-6860
(805) 286-3993
(580) 286-3967
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
6273
OK
207Q00000X
Family Medicine Physician
Primary
6273
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200730970A
—
OK
Enumeration date
03/20/2017
Last updated
03/11/2021
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