MR. Willie J Street, P.A.-C

NPI #1215005244 in Tonkawa, Oklahoma

Provider Information

NPI Number
1215005244
Entity Type
Individual
Name
MR. Willie J Street, P.A.-C
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Physician Assistant
Credential
P.A.-C
Enumeration Date
Nov 30, 2006
Last Updated
Mar 7, 2012

Practice Location

Address
600 E GRAND AVE
ZIP Code
74653-3545
Phone
(580) 628-4800

Specialties & Taxonomy Codes

Specialty
Physician Assistant

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