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Glen Edward Diacon JR., MD
Specialist in Ada, Oklahoma
NPI 1588659957

Glen Edward Diacon JR. is a Specialist based in Ada, OK. Glen Edward Diacon JR. practices in Ada, OK and has the professional credentials of MD. The NPI Number for Glen Edward Diacon JR. is 1588659957 and holds a License No. 16231 (Oklahoma).

The current practice location address for Glen Edward Diacon JR. is 1414 Arlington St, Ada, OK and can be reached out via phone at 580-332-0112 and via fax at 580-332-1005.

Location: 1414 Arlington St, Ada, OK, 74820-2643
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1588659957
Provider Name
Glen Edward Diacon JR.
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1414 Arlington St, Ada, OK, 74820-2643
Phone Number
580-332-0112
Fax Number
580-332-1005
Provider Enumeration Date
09/13/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
100137260A 05 OK
institution
Provider Business Practice Location Address Details
Address
1414 Arlington St
City
Ada
State
Oklahoma
Zip
74820-2643
Phone Number
580-332-0112
Fax Number
580-332-1005
person
Provider Business Mailing Address Details
Address
1414 Arlington St
City
Ada
State
Oklahoma
Zip
74820-2643
Phone Number
580-332-0112
Fax Number
580-332-1005
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
16231 (Oklahoma)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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