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Individual

WELDON JOHN MALLGREN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
17599 S HIGHWAY 88, CLAREMORE, OK 74017-0801
(918) 342-9530
(918) 342-9533
Mailing address
114 W DELAWARE AVE, NOWATA, OK 74048-2601
(918) 342-9530
(918) 342-6852

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2466
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100227390C
OK
Enumeration date
10/03/2006
Last updated
03/01/2011
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