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Next Update: Tuesday, May 7, 2024 2:50 AM CDT

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WALLACE, THEODORE WILLIAM
Practice Address: DYSPHAGIA SERVICES INC
715 GLENRIDGE DRIVE
EDMOND OK 73034

Address last updated on 9/22/2005
Phone #: (405) 721-2879
Fax #:
County: OKLAHOMA
License: 1443
Dated: 5/5/2005
Expires: 3/31/2007
License Type: Physician Assistant
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year: 0
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
DYSPHAGIA SERVICES INC
715 GLENRIDGE DRIVE
EDMOND OK 73034

Phone #: (405) 721-2879
Fax #:

Hospital Privileges:

None listed

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