Glen Edward Diacon (NPI# 1588659957, PAC ID# 8224189410) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is UROLOGY.
| Nation Provider ID (NPI) | 1588659957 |
| PAC ID by PECOS | 8224189410 |
| Professional Enrollment ID | I20110929000646 |
| Full Name | Glen Edward Diacon |
| Organization Legal Name | SOUTHERN OKLAHOMA UROLOGY, INC |
| Address |
1414 Arlington St Suite 2300 Ada OK 74820-2694 |
| Phone Number | 5803320112 |
| Gender | M |
| Medical School | UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE |
| Graduation Year | 1986 |
| Primary Specialty | UROLOGY |
| Group Practice PAC ID | 2961464730 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 370020 | MERCY HOSPITAL ADA |
| 371328 | ARBUCKLE MEMORIAL HOSPITAL |
| 371321 | HOLDENVILLE GENERAL HOSPITAL |
| 370180 | CHICKASAW NATION MEDICAL CENTER |
| 370229 | ALLIANCEHEALTH SEMINOLE |
| Address | Phone | Organization |
|---|---|---|
| 1414 Arlington St, Suite 2300, Ada, OK 74820-2694 | 5803320112 | SOUTHERN OKLAHOMA UROLOGY, INC |
| Organization Legal Name | SOUTHERN OKLAHOMA UROLOGY, INC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mark Christopher Leu | Physician Assistant | Southern Oklahoma Urology, Inc | 1414 Arlington St, Suite 2300, Ada, OK 74820-2694 |
| Phillip T Fuller | Urology | Southern Oklahoma Urology, Inc | 1414 Arlington St, Suite 2300, Ada, OK 74820-2694 |
| Street Address |
1414 ARLINGTON ST SUITE 2300 |
| City | ADA |
| State | OK |
| Zip | 74820-2694 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Grant N Corning | Ophthalmology | 1414 Arlington St, Suite 1400, Ada, OK 74820-2643 | |
| Joe Bourland | Physician Assistant | 1414 Arlington St, Suite 2000, Ada, OK 74820-2613 | |
| Mark Christopher Leu | Physician Assistant | Southern Oklahoma Urology, Inc | 1414 Arlington St, Suite 2300, Ada, OK 74820-2694 |
| Dusty Dennis | Physical Therapy | 1414 Arlington St, Suite 2200, Ada, OK 74820-2694 | |
| Phillip T Fuller | Urology | Southern Oklahoma Urology, Inc | 1414 Arlington St, Suite 2300, Ada, OK 74820-2694 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Austin S Lemay | Clinical Social Worker | Biofeedback and Counseling Inc | 2100 N Broadway Ave, Ada, OK 74820-1048 |
| Steven A Roring | Psychologist, Clinical | Biofeedback and Counseling Inc | 2100 N Broadway Ave, Ada, OK 74820-1048 |
| Walter C Maxcey | Nurse Practitioner | Lansdell Family Clinic Pllc | 1601 N Broadway Ave, Ada, OK 74820-1403 |
| Sherry L Silverstein Alpert | Nurse Practitioner | Lansdell Family Clinic Pllc | 1601 N Broadway Ave, Ada, OK 74820-1403 |
| Jeffery Elliott | Optometry | 1139 Lonnie Abbott Blvd, Ada, OK 74820-1845 | |
| Hubert E Power | Chiropractic | Power Clinic of Chiropractic and Acupuncture, Inc. | 1180 N Hills Shopping Ctr, Ada, OK 74820-1864 |
| Calvin L Nelson Jr. | Chiropractic | Power Clinic of Chiropractic and Acupuncture, Inc. | 1180 N Hills Shopping Ctr, Ada, OK 74820-1864 |
| Michelle Ann Cole | Nurse Practitioner | 709 Better Now Plz, Ada, OK 74820-2279 | |
| Gary Paddack | Internal Medicine | 721 Better Now Plaza, Ada, OK 74820-2279 | |
| Mona J Nickerson | Nurse Practitioner | Bruce W Dennis Md Pllc | 721 Better Now Plaza, Ada, OK 74820-2279 |
| Find all physicians in zip 74820 | |||
| City | ADA |
| Zip Code | 74820 |
| Specialty | UROLOGY |
| City + Specialty | ADA + UROLOGY |
Please comment or provide details below to improve the information on Glen Edward Diacon.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.