Individual
STEPHEN VANCE PAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
20 12TH AVE NW, ARDMORE, OK 73401-5722
(580) 223-3411
(580) 226-6213
Mailing address
20 12TH AVE NW, ARDMORE, OK 73401-5722
(580) 223-3411
(580) 226-6213
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA770
OK
363AM0700X
Medical Physician Assistant
Primary
PA770
OK
Other
Enumeration date
06/09/2011
Last updated
06/09/2011
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