Individual
MR. PAUL EDWARD CALLICOAT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 E 13TH ST, SUITE 200, GROVE, OK 74344-2975
(918) 786-7667
(918) 786-7699
Mailing address
PO BOX 450968, GROVE, OK 74345-0968
(918) 786-7667
(918) 786-7699
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
17987
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100034060A
—
OK
Enumeration date
07/18/2005
Last updated
05/20/2010
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