Individual
ELIZABETH A WICKERSHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4345 W MEMORIAL RD, SUITE 110, OKLAHOMA CITY, OK 73134-1702
(405) 418-7000
(405) 418-7099
Mailing address
4345 W MEMORIAL RD, SUITE 110, OKLAHOMA CITY, OK 73134-1702
(405) 418-7000
(405) 418-7099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20273
OK
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
20273
OK
208VP0000X
Pain Medicine Physician
20273
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200036870A
—
OK
Enumeration date
08/10/2005
Last updated
10/25/2023
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