Organization
DAVENPORT MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY WOHLGEMUTH (MANAGER)
(405) 249-9611
Entity
Organization
Contact information
Practice address
203 N BROADWAY, DAVENPORT, OK 74026
(405) 249-9611
Mailing address
203 N BROADWAY, DAVENPORT, OK 74026
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
242
OK
Other
Enumeration date
03/29/2011
Last updated
03/29/2011
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