Provider Demographics
NPI:1053306571
Name:PAULGER, NANCY S (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:S
Last Name:PAULGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 GREENBRIAR PL
Mailing Address - Street 2:SUITE 700
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7645
Mailing Address - Country:US
Mailing Address - Phone:405-703-2100
Mailing Address - Fax:405-703-2103
Practice Address - Street 1:1625 GREENBRIAR PL
Practice Address - Street 2:SUITE 700
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7645
Practice Address - Country:US
Practice Address - Phone:405-703-2100
Practice Address - Fax:405-703-2103
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-09-28
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
OK13233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100660AMedicaid
OK080165190Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OK100100660AMedicaid