Wallace B McLeod III, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WALLACE B MCLEOD III, INC

Practice address

2216 N Martin Luther King Ave
Oklahoma City, OK 73111-2445

Phone

(405) 424-0111

NPI assigned

May 27, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jessie Mae Shambra

Title

Office Manager

Phone

(405) 424-0111

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Wallace B McLeod III2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wallace B. McLeod III, Inc

  • Ph.D. Medical Genetics
  • Oklahoma City, OK
  • NPI 1861711731
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wallace Beverly McLeod III, M.D

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1922035237
  NPD
• Marshall Krizoa Nguessan, AUD.

  • Audiologist
  • Lawton, OK
  • NPI 1689670077
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1194044313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 N MARTIN LUTHER KING AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731112445",
            "telephone_number": "405-424-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2216 N MARTIN LUTHER KING AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731112445",
            "telephone_number": "405-424-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE B MCLEOD III, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "SHAMBRA",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-424-0111",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05538623602",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Casie Shay Wall, APRN, FNP-C
• James Frank Wall, MD
• Jesse Wall
• Madison Wall
• Raymond Louis Wall, M.D.
• Wallace B. McLeod III, Inc
• Wallace Foot and Ankle Center, PLLC
• Alexis Wallace
• Bailey Layne Wallace
• Johnna Wallace, AUD

• Family Medicine Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.