Provider Demographics
NPI:1043351661
Name:WOMBLE, JOE RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:RUSSELL
Last Name:WOMBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HEALTHPLEX PKWY
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9749
Mailing Address - Country:US
Mailing Address - Phone:405-515-1000
Mailing Address - Fax:
Practice Address - Street 1:920 STANTON L YOUNG BLVD
Practice Address - Street 2:WP 1130
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5020
Practice Address - Country:US
Practice Address - Phone:405-271-5963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine