Provider Demographics
NPI:1588702617
Name:MCGUIRE, PAUL MONROE (CPO)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MONROE
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE #310
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5222
Mailing Address - Country:US
Mailing Address - Phone:907-561-2837
Mailing Address - Fax:907-561-6128
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE #310
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5222
Practice Address - Country:US
Practice Address - Phone:907-561-2837
Practice Address - Fax:907-561-6128
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACPO010171744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPO1017Medicaid