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Individual

PAUL HULTMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
3401 MCINTOSH CIR STE 100, JOPLIN, MO 64804-3651
(417) 347-7200
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 347-4662

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
109308
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200071950A
OK
05
200362690A
KS
01
205692
ANTHEM
MO
01
P00279795
RR MEDICARE
Enumeration date
06/18/2006
Last updated
03/19/2024
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