Provider Demographics
NPI:1295025559
Name:HART, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4462
Mailing Address - Country:US
Mailing Address - Phone:405-942-5442
Mailing Address - Fax:405-942-6448
Practice Address - Street 1:3366 NW EXPRESSWAY
Practice Address - Street 2:SUITE 550
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4462
Practice Address - Country:US
Practice Address - Phone:405-942-5442
Practice Address - Fax:405-942-6448
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical