Provider Demographics
NPI:1780684357
Name:AHEARN, PAMELA E (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:E
Last Name:AHEARN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:E
Other - Last Name:DELASHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5012 US HWY 75 S, SUITE 300
Mailing Address - Street 2:ATT: BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:580-920-2273
Mailing Address - Fax:580-920-9978
Practice Address - Street 1:714 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439
Practice Address - Country:US
Practice Address - Phone:580-564-0200
Practice Address - Fax:580-564-0201
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2077207Q00000X
OK19862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100102140BMedicaid
OK080192384Medicare PIN
OK100102140BMedicaid
G45848Medicare UPIN