Provider Demographics
NPI:1033211941
Name:BIZZLE, PAUL G (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:BIZZLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1799
Mailing Address - Country:US
Mailing Address - Phone:918-453-0023
Mailing Address - Fax:918-453-0023
Practice Address - Street 1:327 HICKORY DR
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5115
Practice Address - Country:US
Practice Address - Phone:918-453-0023
Practice Address - Fax:918-453-0023
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3240207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200033584OtherRAILROAD MEDICARE
OK0516550001OtherCIGNA GOVERNMENT SERVICES
249527004Medicare ID - Type Unspecified
OK0516550001OtherCIGNA GOVERNMENT SERVICES
E55529Medicare UPIN