Healthcare Provider Details

I. General information

NPI: 1700814845
Provider Name (Legal Business Name): PAUL D ADDISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

PO BOX 26303
OKLAHOMA CITY OK
73126-0303
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-7041
  • Fax:
Mailing address:
  • Phone: 405-947-8584
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number17535
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: