Organization
JOINT RECONSTRUCTIVE SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL D MAITINO DO. (PRESIDENT)
(405) 680-5633
Entity
Organization
Contact information
Practice address
3110 SW 89TH ST, STE 200 D, OKLAHOMA CITY, OK 73159-7920
(405) 680-5633
(405) 735-6435
Mailing address
PO BOX 108809, OKLAHOMA CITY, OK 73101-8809
(405) 419-8444
(405) 419-7797
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
3588
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200038126
MEDICARE RAILROAD
OK
05
—
200075360A
—
OK
Enumeration date
08/30/2006
Last updated
02/05/2013
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