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Individual

TAELOR BAETZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
415 FAIRVIEW AVE STE 201, PONCA CITY, OK 74601-1932
(580) 762-9355
(580) 762-9358
Mailing address
3001 QUAIL SPRINGS PKWY FL 5, OKLAHOMA CITY, OK 73134-2640
(580) 762-9355
(580) 762-9358

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5266
OK

Other

Enumeration date
05/15/2023
Last updated
07/10/2024
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