Basic Information
Provider Information
NPI: 1184393845
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OROZCO
FirstName: PAUL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: AA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 840848
Address2:  
City: DALLAS
State: TX
PostalCode: 752840857
CountryCode: US
TelephoneNumber: 9722831999
FaxNumber: 9722332666
Practice Location
Address1: 3300 NW EXPRESSWAY
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731124418
CountryCode: US
TelephoneNumber: 4059512815
FaxNumber: 4059512495
Other Information
ProviderEnumerationDate: 09/07/2021
LastUpdateDate: 09/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367H00000X32698013OKY Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 

No ID Information.


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