Healthcare Provider Details

I. General information

NPI: 1982602025
Provider Name (Legal Business Name): PAUL STEVENS GILLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2413 PALMER CIR
NORMAN OK
73069-6301
US

IV. Provider business mailing address

2413 PALMER CIR
NORMAN OK
73069-6301
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-9588
  • Fax: 405-321-5348
Mailing address:
  • Phone: 405-360-9588
  • Fax: 405-321-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number18048
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number18408
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: