Healthcare Provider Details

I. General information

NPI: 1689669905
Provider Name (Legal Business Name): DAVID M PAGNANELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 SW LEE BLVD SUITE 357
LAWTON OK
73505-9681
US

IV. Provider business mailing address

5604 SW LEE BLVD SUITE 357
LAWTON OK
73505-9681
US

V. Phone/Fax

Practice location:
  • Phone: 580-531-4600
  • Fax: 580-531-6405
Mailing address:
  • Phone: 580-531-4600
  • Fax: 580-531-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number23774
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: