Healthcare Provider Details

I. General information

NPI: 1982732640
Provider Name (Legal Business Name): PAUL J VIETH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S MONROE
ENID OK
73701
US

IV. Provider business mailing address

3601 N MAY AVE # AV3 STE C
OKLAHOMA CITY OK
73112-6641
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-2300
  • Fax: 580-548-1298
Mailing address:
  • Phone: 405-604-5613
  • Fax: 405-601-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number59
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: