Provider Demographics
NPI:1245326925
Name:ADLAON, WELLIE P (MD)
Entity type:Individual
Prefix:DR
First Name:WELLIE
Middle Name:P
Last Name:ADLAON
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 1:508 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-3214
Mailing Address - Country:US
Mailing Address - Phone:580-371-9117
Mailing Address - Fax:580-371-9101
Practice Address - Street 1:508 E 24TH ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-3214
Practice Address - Country:US
Practice Address - Phone:580-371-9117
Practice Address - Fax:580-371-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100224990BMedicaid
OK249403001Medicare ID - Type Unspecified
OKG98241Medicare UPIN