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General NPI Number Information
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NPI Number | 1972599454
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Entity Type | Individual
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Provider Name | JAMES PAUL ICE MD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 36 W MEMORIAL RD STE C3
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-2312
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Country | US
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Telephone | 405-755-3110
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Fax | 405-755-3159
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Provider Business Mailing Address
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Address Line | 36 W MEMORIAL RD STE C3
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-2312
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Country | US
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Telephone | 405-755-3110
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Fax | 405-755-3159
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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 | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 17299
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 17299
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License Number State | OK
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