Individual
WANDA I. DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1902 E GORE BLVD, LAWTON, OK 73501-6102
(580) 357-4200
Mailing address
1902 E GORE BLVD, LAWTON, OK 73501-6102
(580) 357-4200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
038217
GA
207P00000X
Emergency Medicine Physician
Primary
27633
OK
Other
Enumeration date
06/11/2007
Last updated
10/01/2012
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