Provider Demographics
NPI:1396713764
Name:HOBBS, PAUL WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WAYNE
Last Name:HOBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1008
Mailing Address - Country:US
Mailing Address - Phone:918-207-0991
Mailing Address - Fax:918-207-0989
Practice Address - Street 1:1328 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-7650
Practice Address - Country:US
Practice Address - Phone:918-683-0470
Practice Address - Fax:918-207-0989
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100151900AMedicaid
OK100151900AMedicaid
OK243630401Medicare PIN
OKOK403695Medicare PIN