Provider Demographics
NPI:1922339290
Name:MEDGAARDEN, ALEX E (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:E
Last Name:MEDGAARDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16325 N MAY AVE STE B6
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9142
Mailing Address - Country:US
Mailing Address - Phone:405-920-3901
Mailing Address - Fax:405-920-3899
Practice Address - Street 1:16325 N MAY AVE STE B6
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9142
Practice Address - Country:US
Practice Address - Phone:405-920-3901
Practice Address - Fax:405-920-3899
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2022-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1876363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant