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General NPI Number Information
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NPI Number | 1598769275
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Entity Type | Individual
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Provider Name | PAUL A OVERLIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 3514 21ST ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1210
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Country | US
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Telephone | 806-725-1801
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Fax | 806-723-7535
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Provider Business Mailing Address
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Address Line | 2215 NASHVILLE AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-1105
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Country | US
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Telephone | 806-725-5844
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Fax | 806-723-6532
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | H5345
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License Number State | TX
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