Organization
ROBERT L WADDELL MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LUTHER WADDELL MD (OWNER)
(580) 310-0102
Entity
Organization
Contact information
Practice address
435 N. MONTE VISTA, ADA, OK 74820-4676
(580) 310-0102
(580) 310-0104
Mailing address
P.O. BOX 1660, ADA, OK 74821-1660
(580) 310-0102
(580) 310-0104
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20345
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100155110A
—
OK
Enumeration date
04/27/2009
Last updated
05/26/2011
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