Provider Demographics
NPI:1073594354
Name:FIRTH, PAUL LYNN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LYNN
Last Name:FIRTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-1647
Mailing Address - Country:US
Mailing Address - Phone:580-225-4466
Mailing Address - Fax:580-225-2417
Practice Address - Street 1:503 W COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-1647
Practice Address - Country:US
Practice Address - Phone:580-225-4466
Practice Address - Fax:580-225-2417
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19810208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG72117Medicare ID - Type UnspecifiedU-PIN