Basic Information
| Provider Information | |||||||||
| NPI: | 1801497672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WANT | ||||||||
| FirstName: | COLTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 SAN SIMEON DR | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730035943 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3625 NW 56TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059512855 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2020 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39463 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.