Healthcare Provider Details

I. General information

NPI: 1316124605
Provider Name (Legal Business Name): JORG JOHANNES PAHL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 N CLASSEN BLVD STE 200
OKLAHOMA CITY OK
73118-2650
US

IV. Provider business mailing address

3909 N CLASSEN BLVD STE 200
OKLAHOMA CITY OK
73118-2650
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-6500
  • Fax: 405-525-3700
Mailing address:
  • Phone: 405-525-6500
  • Fax: 405-525-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number17260
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: