Individual
MICHAEL RYAN VACLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4150 SE ADAMS RD, BARTLESVILLE, OK 74104-8410
(918) 331-9979
(918) 331-2346
Mailing address
4150 SE ADAMS RD, BARTLESVILLE, OK 74006
(918) 331-9979
(918) 331-2346
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19519
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100230530A
—
OK
05
—
100255000A
—
OK
Enumeration date
09/13/2005
Last updated
04/29/2010
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