Provider Demographics
NPI:1790893741
Name:DARDEN, PAUL M II (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:DARDEN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251418
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1418
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:405-271-8709
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:SUITE 6100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-6827
Practice Address - Fax:405-271-4418
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13780208000000X
OK26715208000000X
ARE-14871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC137809Medicaid
SCB91582Medicare ID - Type Unspecified
SC137809Medicaid