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General NPI Number Information
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NPI Number | 1023302007
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Entity Type | Individual
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Provider Name | NICOLE PAOLA MATHES MD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 800 W BOISE CIR STE 160
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City | BROKEN ARROW
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State | OK
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Zip | 74012-4932
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Country | US
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Telephone | 918-994-9166
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Fax | 918-403-6306
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Provider Business Mailing Address
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Address Line | 1923 S UTICA AVE
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City | TULSA
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State | OK
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Zip | 74104-6520
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Country | US
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Telephone | 918-403-7065
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Fax | 918-744-2946
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S3238
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License Number State | TX
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