Provider Demographics
NPI:1144221425
Name:HOUK, PAUL E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:HOUK
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 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:217-525-3664
Practice Address - Street 1:1025 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2403
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:217-528-7541
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85-000937363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL85-000937OtherSTATE LICENSE NUMBER
IL1034360OtherNCCPA-NAT. COM CERT OF PA
IL385-000531OtherPA CONTROLLED SUBSTANCE
IA1112OtherSTATE LICENSE
IA5100395OtherSTATE CONTROLLED SUBSTANC
TN552OtherSTATE LICENSE
MH0323256OtherFEDERAL DEA
IA1112OtherSTATE LICENSE
MH0323256OtherFEDERAL DEA