Organization
ADA GYNECOLOGY & OBSTETRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIMMY B WALLACE M.D. (OWNER)
(580) 436-9088
Entity
Organization
Contact information
Practice address
1414 ARLINGTON ST STE 1700, ADA, OK 74820-2694
(580) 436-9088
(580) 436-0035
Mailing address
1414 ARLINGTON ST STE 1700, ADA, OK 74820-2694
(580) 436-9088
(580) 436-0035
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
8279
OK
Other
Enumeration date
04/09/2007
Last updated
08/22/2020
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