Provider Demographics
NPI:1437191137
Name:MARUT, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:MARUT
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-751-3183
Practice Address - Street 1:4101 TORRANCE BLVD
Practice Address - Street 2:EM DEPT
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4607
Practice Address - Country:US
Practice Address - Phone:310-540-7676
Practice Address - Fax:405-751-3183
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG69258207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G692580Medicaid
CA00G692580Medicaid
CAWG69258FMedicare PIN