Provider Demographics
NPI:1992786073
Name:ASTON, PATRICE ADELE (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:ADELE
Last Name:ASTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:ADELE
Other - Last Name:ASTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3400 NW EXPRESSWAY
Mailing Address - Street 2:BLD C #815
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4493
Mailing Address - Country:US
Mailing Address - Phone:405-945-4990
Mailing Address - Fax:405-945-4991
Practice Address - Street 1:3400 NW EXPRESSWAY
Practice Address - Street 2:BLD C #815
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-945-4990
Practice Address - Fax:405-945-4991
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2005208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D42532Medicare UPIN