Provider Demographics
NPI:1689669905
Name:PAGNANELLI, DAVID M (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:PAGNANELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5604 SW LEE BLVD
Mailing Address - Street 2:SUITE 357
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9681
Mailing Address - Country:US
Mailing Address - Phone:580-531-4600
Mailing Address - Fax:580-531-6405
Practice Address - Street 1:5604 SW LEE BLVD
Practice Address - Street 2:SUITE 357
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9681
Practice Address - Country:US
Practice Address - Phone:580-531-4600
Practice Address - Fax:580-531-6405
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23774207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200035200AMedicaid
OK200035200AMedicaid
248424101Medicare PIN