Organization
ADVANCED UROLOGY AND WELLNESS CENTER OF MUSKOGEE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEWELL LEE DANIELS JR. MD (DIRECTOR)
(918) 683-5025
Entity
Organization
Contact information
Practice address
4200 W OKMULGEE ST, MUSKOGEE, OK 74401-4646
(918) 683-5025
(918) 913-9703
Mailing address
4200 W OKMULGEE ST, MUSKOGEE, OK 74401-4646
(918) 683-5025
(918) 913-9703
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
23095
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200044610A
—
OK
Enumeration date
08/21/2007
Last updated
04/16/2013
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