Healthcare Provider Details

I. General information

NPI: 1396713764
Provider Name (Legal Business Name): PAUL WAYNE HOBBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 S YORK ST
MUSKOGEE OK
74403-7650
US

IV. Provider business mailing address

PO BOX 1008
TAHLEQUAH OK
74465-1008
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-0470
  • Fax: 918-207-0989
Mailing address:
  • Phone: 918-207-0991
  • Fax: 918-207-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11622
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: