Provider Demographics
NPI:1790257616
Name:POWELL, LADON DWIGHT
Entity Type:Individual
Prefix:MR
First Name:LADON
Middle Name:DWIGHT
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 N CLASSEN BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2668
Mailing Address - Country:US
Mailing Address - Phone:405-524-2424
Mailing Address - Fax:
Practice Address - Street 1:4001 N CLASSEN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2668
Practice Address - Country:US
Practice Address - Phone:405-524-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist