Healthcare Provider Details

I. General information

NPI: 1306818984
Provider Name (Legal Business Name): PAUL D ROTHWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 GRANT BLVD STE 108
YUKON OK
73099-0038
US

IV. Provider business mailing address

4400 GRANT BLVD STE 108
YUKON OK
73099-0038
US

V. Phone/Fax

Practice location:
  • Phone: 405-787-8550
  • Fax: 405-789-6734
Mailing address:
  • Phone: 405-470-8200
  • Fax: 405-789-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10533
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: