| Organization Name: | CANADIAN VALLEY CLINIC INC |
| NPI Number: | 1700956240 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANNE L WALDE (SECRETARY) |
| Mailing Address: | 2001 Parkview Dr El Reno |
| State: | OK US |
| Postal Code: | 730362107 |
| Phone Number: | 4052622114 |
| Fax Number: | 4052622306 |
| NPI Enumeration Date: | 11/09/2006 |
| NPI Last Update Date: | 06/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |