Individual
MILES COLEMAN WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2226 E 38TH ST, TULSA, OK 74105-3406
(918) 671-6400
Mailing address
5800 N ROSS AVE, OKLAHOMA CITY, OK 73112-7016
(918) 671-6400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
45921
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/18/2021
Last updated
06/11/2025
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