Organization
WALLACE B. MCLEOD III, INC
Active
Other names
Wallace B. McLeod III, M.D
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSIE MAE SHAMBRA (OFFICE MANAGER)
(405) 424-0111
Entity
Organization
Contact information
Practice address
2216 N MARTIN LUTHER KING AVE, OKLAHOMA CITY, OK 73111-2445
(405) 424-0111
Mailing address
2216 N MARTIN LUTHER KING AVE, OKLAHOMA CITY, OK 73111-2445
(405) 424-0111
(405) 424-0115
Taxonomy
Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
Primary
15393
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05538623602
—
OK
Enumeration date
05/18/2010
Last updated
05/18/2010
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