Provider Demographics
NPI:1093382467
Name:PARAGON GERIATRIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PARAGON GERIATRIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:VERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-400-7557
Mailing Address - Street 1:5601 NW 72ND ST STE 245
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5948
Mailing Address - Country:US
Mailing Address - Phone:405-400-7557
Mailing Address - Fax:844-868-8139
Practice Address - Street 1:5601 NW 72ND ST STE 245
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-5948
Practice Address - Country:US
Practice Address - Phone:405-400-7557
Practice Address - Fax:844-868-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty