Provider Demographics
NPI:1013094101
Name:JOACHIM, BILL DAVIS (PA)
Entity Type:Individual
Prefix:MR
First Name:BILL
Middle Name:DAVIS
Last Name:JOACHIM
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2482 COUNTY ROAD 1205
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-2804
Mailing Address - Country:US
Mailing Address - Phone:405-270-0501
Mailing Address - Fax:405-297-5948
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-270-0501
Practice Address - Fax:405-297-5948
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK242363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical