Provider Demographics
NPI:1245208941
Name:MCQUILLEN, PAUL WILSON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILSON
Last Name:MCQUILLEN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:SUITE302
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2495
Mailing Address - Country:US
Mailing Address - Phone:918-331-2468
Mailing Address - Fax:918-331-2469
Practice Address - Street 1:3400 E FRANK PHILLIPS BLVD
Practice Address - Street 2:SUITE302
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2495
Practice Address - Country:US
Practice Address - Phone:918-331-2468
Practice Address - Fax:918-331-2469
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
OK11814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F65582Medicare UPIN