| J. Russell Womble, Pllc | |
|
901 N Porter Norman OK 73071-6419 | |
| (405) 359-2372 | |
| (405) 307-3018 |
| Full Name | J. Russell Womble, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 901 N Porter, Norman, Oklahoma |
| Authorized Official Name and Position | Joe Russell Womble (OWNER) |
| Authorized Official Contact | 4053071000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Russell Womble, Pllc 839 Ne 19th Street Oklahoma City OK 73105-8227 Ph: (405) 359-2372 | J. Russell Womble, Pllc 901 N Porter Norman OK 73071-6419 Ph: (405) 359-2372 |
| NPI Number | 1538399845 |
|---|---|
| Provider Enumeration Date | 07/21/2009 |
| Last Update Date | 05/12/2010 |
| Medicare PECOS PAC ID | 8729131115 |
|---|---|
| Medicare Enrollment ID | O20090803000312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538399845 | NPI | - | NPPES |
| 1043351661 | Other | OK | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25035 (Oklahoma) | Primary |
| Provider Name | Joe R Womble |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1043351661 PECOS PAC ID: 3375696768 Enrollment ID: I20090803000308 |
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