Provider Demographics
NPI:1386829125
Name:PAUL, ROBERT WILLIAM (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:PAUL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 6TH STREET
Mailing Address - Street 2:P. O. BOX 157
Mailing Address - City:RYAN
Mailing Address - State:OK
Mailing Address - Zip Code:73565-0157
Mailing Address - Country:US
Mailing Address - Phone:580-757-2451
Mailing Address - Fax:580-757-2650
Practice Address - Street 1:1104 6TH STREET
Practice Address - Street 2:
Practice Address - City:RYAN
Practice Address - State:OK
Practice Address - Zip Code:73565-0157
Practice Address - Country:US
Practice Address - Phone:580-757-2451
Practice Address - Fax:580-757-2650
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant