Glen Edward Diacon JR., MD

NPI #1588659957 in Ada, Oklahoma

Provider Information

NPI Number: 1588659957
Entity Type: Individual
Name: Glen Edward Diacon JR., MD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: MD
Enumeration Date: Sep 13, 2005
Last Updated: Aug 11, 2010

Practice Location

Address: 1414 ARLINGTON ST
Address 2: SUITE 2300
City: Ada
State: Oklahoma
ZIP Code: 74820-2643
Phone: (580) 332-0112

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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