Provider Demographics
NPI:1629187596
Name:JOINT RECONSTRUCTIVE SPECIALIST
Entity Type:Organization
Organization Name:JOINT RECONSTRUCTIVE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAITINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-680-5633
Mailing Address - Street 1:PO BOX 108809
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8809
Mailing Address - Country:US
Mailing Address - Phone:405-419-8444
Mailing Address - Fax:405-419-7797
Practice Address - Street 1:3110 SW 89TH ST
Practice Address - Street 2:STE 200 D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7920
Practice Address - Country:US
Practice Address - Phone:405-680-5633
Practice Address - Fax:405-735-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3588207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200075360AMedicaid
OK200038126OtherMEDICARE RAILROAD
OK200075360AMedicaid