Provider Demographics
NPI:1679506844
Name:WALIA, JO (MD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:WALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:DEPT 963410
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-3410
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1583
Practice Address - Street 1:1201 HEALTH CENTER PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6381
Practice Address - Country:US
Practice Address - Phone:405-717-6800
Practice Address - Fax:405-717-7964
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-09-27
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Provider Licenses
StateLicense IDTaxonomies
OK13213207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D35377Medicare UPIN