MEDICARE: AARON WAYNE HEAD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	865	OK

General Provider Information

NPI Number	:	1316955073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON WAYNE HEAD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	MEEKER
State	:	OK
Zip	:	74855-0190
Country	:	US
Telephone Number	:	405-416-3739
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 S MACARTHUR BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73169-6918
Country	:	US
Telephone Number	:	405-954-3711
Fax Number	:	405-954-9112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	11/05/2012

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Directions to “ AARON WAYNE HEAD PA-C” Practice Location

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