MEDICARE: RONALD EUGENE PAULS 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	363A00000X	Physician Assistant	1702	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1702	OTHER	OK	PA LICENSE

General Provider Information

NPI Number	:	1912182627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD EUGENE PAULS PA-C

Provider Business Mailing Address
First Line	:	2403 W WRANGLER BLVD STE A
Second Line	:
City	:	SEMINOLE
State	:	OK
Zip	:	74868-1900
Country	:	US
Telephone Number	:	405-382-4939
Fax Number	:	405-382-4947

Provider Business Practice Location Address
First Line	:	2403 W WRANGLER BLVD STE A
Second Line	:
City	:	SEMINOLE
State	:	OK
Zip	:	74868-1900
Country	:	US
Telephone Number	:	405-382-4939
Fax Number	:	405-382-4947

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

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	01/02/2008

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