Justin K Wallace, D.V.M.

Primary specialty

VeterinarianTaxonomy code 174M00000X

License

5380 Issued in OK

Practice address

120 S 6TH St
Chickasha, OK 73018-3420

Phone

(405) 224-8023

Fax

(405) 224-8024

NPI assigned

Nov 8, 2013

Last updated

Nov 8, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383868800000",
    "number": "1649609728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 S 6TH ST",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730183420",
            "telephone_number": "405-224-8023",
            "fax_number": "405-224-8024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S 6TH ST",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730183420",
            "telephone_number": "405-224-8023",
            "fax_number": "405-224-8024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JUSTIN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "D.V.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-08",
        "last_updated": "2013-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174M00000X",
            "taxonomy_group": "",
            "desc": "Veterinarian",
            "state": "OK",
            "license": "5380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Veterinarian in Chickasha, OK
• Providers in Chickasha, OK by specialty
• Veterinarian in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; 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.