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General NPI Number Information
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NPI Number | 1629187596
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Entity Type | Organization
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Legal Business Name | JOINT RECONSTRUCTIVE SPECIALIST
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 3110 SW 89TH ST STE 200 D
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7920
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Country | US
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Telephone | 405-680-5633
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Fax | 405-735-6435
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Provider Business Mailing Address
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Address Line | PO BOX 108809
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City | OKLAHOMA CITY
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State | OK
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Zip | 73101-8809
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Country | US
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Telephone | 405-419-8444
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Fax | 405-419-7797
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL D MAITINO
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Credential | DO.
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Telephone | 405-680-5633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 3588
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License Number State | OK
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