Provider Demographics
NPI:1134536774
Name:WESTERN OKLAHOMA UROLOGY PLLC
Entity type:Organization
Organization Name:WESTERN OKLAHOMA UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOOTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-243-2200
Mailing Address - Street 1:1800 W 1ST ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-3133
Mailing Address - Country:US
Mailing Address - Phone:580-243-2200
Mailing Address - Fax:580-243-0812
Practice Address - Street 1:1800 W 1ST ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-3133
Practice Address - Country:US
Practice Address - Phone:580-243-2200
Practice Address - Fax:580-243-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30463208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty