Provider Demographics
NPI:1699837203
Name:POWERS, PAUL J (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:POWERS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2210 DUNCAN REGIONAL LOOP
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1564
Mailing Address - Country:US
Mailing Address - Phone:580-252-3400
Mailing Address - Fax:580-252-7829
Practice Address - Street 1:2815 W ELK AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1591
Practice Address - Country:US
Practice Address - Phone:580-252-3400
Practice Address - Fax:580-252-7829
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2019-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPA1416363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ40246Medicare UPIN