Provider Demographics
NPI:1043276694
Name:COMPTON, GROVER LEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GROVER
Middle Name:LEN
Last Name:COMPTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BOILING SPRINGS EST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-9506
Mailing Address - Country:US
Mailing Address - Phone:580-254-2172
Mailing Address - Fax:580-571-8038
Practice Address - Street 1:1650 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3046
Practice Address - Country:US
Practice Address - Phone:580-571-8050
Practice Address - Fax:580-571-8038
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK973363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096390IMedicaid
OKOK401649Medicare PIN
OK243404205Medicare PIN
OK100096390IMedicaid