Provider Demographics
NPI:1417950221
Name:ORR, PAUL D (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:ORR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1607
Mailing Address - Country:US
Mailing Address - Phone:909-621-3916
Mailing Address - Fax:909-625-0903
Practice Address - Street 1:430 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1607
Practice Address - Country:US
Practice Address - Phone:909-621-3916
Practice Address - Fax:909-625-0903
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC22925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C229250Medicaid
CA00C229250Medicaid
CAC22925Medicare ID - Type Unspecified