Provider Demographics
NPI:1164561270
Name:PACE, PATRICE DIANE (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:DIANE
Last Name:PACE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:7912 E 31ST CT
Mailing Address - Street 2:STE 220
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1315
Mailing Address - Country:US
Mailing Address - Phone:918-743-8200
Mailing Address - Fax:918-743-8609
Practice Address - Street 1:3300 CHANDLER RD STE 107
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4909
Practice Address - Country:US
Practice Address - Phone:800-993-8244
Practice Address - Fax:404-494-7537
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-06-05
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Provider Licenses
StateLicense IDTaxonomies
OK4567207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK207Q00000XOtherTAXONOMY CODE