Healthcare Provider Details

I. General information

NPI: 1033211941
Provider Name (Legal Business Name): PAUL G BIZZLE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 HICKORY DR
TAHLEQUAH OK
74464-5115
US

IV. Provider business mailing address

PO BOX 1799
TAHLEQUAH OK
74465-1799
US

V. Phone/Fax

Practice location:
  • Phone: 918-453-0023
  • Fax: 918-453-0023
Mailing address:
  • Phone: 918-453-0023
  • Fax: 918-453-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number3240
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200033584
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier0516550001
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerCIGNA GOVERNMENT SERVICES

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: