Individual
DR. WALLACE BEVERLY MCLEOD III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2216 N MARTIN LUTHER KING AVE, OKLAHOMA CITY, OK 73111-2404
(405) 424-0111
(405) 424-0115
Mailing address
2216 N MARTIN LUTHER KING AVE, OKLAHOMA CITY, OK 73111-2404
(405) 424-0111
(405) 424-0115
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15393
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15393
STATE LICENSURE
OK
01
—
1861711731
GROUP NPI
OK
Enumeration date
06/26/2006
Last updated
06/19/2014
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