Individual
MR. ROBERT LUTHER WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
435 N MONTE VISTA, ADA, OK 74820
(580) 310-0102
(580) 310-0104
Mailing address
530 N MONTE VISTA ST, SUITE A, ADA, OK 74820-4675
(580) 436-7101
(580) 436-4447
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20345
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10015510A
—
OK
Enumeration date
09/08/2006
Last updated
10/27/2014
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