Provider Demographics
NPI:1205899333
Name:PASZKOWIAK, JAROSLAW K (MD)
Entity type:Individual
Prefix:
First Name:JAROSLAW
Middle Name:K
Last Name:PASZKOWIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5903 NW LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1306
Mailing Address - Country:US
Mailing Address - Phone:580-704-7906
Mailing Address - Fax:580-248-3715
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:580-248-8001
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK247628502Medicare PIN