Provider Demographics
NPI:1407901085
Name:DEUPREE, PAULA ANN (DO)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANN
Last Name:DEUPREE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:ANN
Other - Last Name:SLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:13509 N MERIDIAN AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8396
Mailing Address - Country:US
Mailing Address - Phone:405-755-2273
Mailing Address - Fax:405-751-3505
Practice Address - Street 1:13509 N MERIDIAN AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8396
Practice Address - Country:US
Practice Address - Phone:405-755-2273
Practice Address - Fax:405-751-3505
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41362085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH7852Medicare UPIN