Provider Demographics
NPI:1083800148
Name:PAVLAS, JANE MARIA (PA-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIA
Last Name:PAVLAS
Suffix:
Gender:F
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 1:6205 N SANTE FE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7536
Mailing Address - Country:US
Mailing Address - Phone:405-427-6776
Mailing Address - Fax:405-419-5475
Practice Address - Street 1:14024 QUAIL POINTE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1006
Practice Address - Country:US
Practice Address - Phone:405-419-8420
Practice Address - Fax:405-419-8460
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200216550AMedicaid
OK200216550AMedicaid