Provider Demographics
NPI:1154362416
Name:MALDONADO, JUAN A (MD,)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1370 N INTERSTATE DR
Mailing Address - Street 2:SUITE 154
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3376
Mailing Address - Country:US
Mailing Address - Phone:405-247-7346
Mailing Address - Fax:405-247-7565
Practice Address - Street 1:424 SE 11TH ST
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-4442
Practice Address - Country:US
Practice Address - Phone:405-247-7346
Practice Address - Fax:405-247-7565
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100220300AMedicaid
OKD32315Medicare UPIN