Provider Demographics
NPI:1790887263
Name:JAROSLAW K PASZKOWIAK MD PC
Entity Type:Organization
Organization Name:JAROSLAW K PASZKOWIAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAROSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:PASZKOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-248-8000
Mailing Address - Street 1:4411 W GORE BLVD
Mailing Address - Street 2:STE B1
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5977
Mailing Address - Country:US
Mailing Address - Phone:580-248-8000
Mailing Address - Fax:580-248-8001
Practice Address - Street 1:4411 W GORE BLVD
Practice Address - Street 2:STE B1
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-248-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200082480BMedicaid
OK200095800AMedicaid
OKP00435232OtherMEDICARE RAILROAD
OK=========OtherAETNA
OK200095800AMedicaid
OKP00435232OtherMEDICARE RAILROAD
OK200095800AMedicaid
OK200082480BMedicaid