Provider Demographics
NPI:1447430160
Name:ANGLIN, JOHN ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:ANGLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6898
Mailing Address - Country:US
Mailing Address - Phone:405-943-0303
Mailing Address - Fax:405-272-0515
Practice Address - Street 1:820 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6898
Practice Address - Country:US
Practice Address - Phone:405-943-0303
Practice Address - Fax:405-272-0515
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0087009163W00000X
OK2122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse