Provider Demographics
NPI:1932720349
Name:WALLEN, TONY GLEN (DO)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:GLEN
Last Name:WALLEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1921 STONECIPHER DR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3439
Mailing Address - Country:US
Mailing Address - Phone:580-436-3980
Mailing Address - Fax:580-421-2970
Practice Address - Street 1:2800 STATE HIGHWAY 24 STE A
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-2017
Practice Address - Country:US
Practice Address - Phone:903-886-3161
Practice Address - Fax:903-453-3923
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2024-11-12
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Provider Licenses
StateLicense IDTaxonomies
OK7421207Q00000X
TXV1914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine