Individual
DR. JOHN DERICK PAULSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
530 S MAIDEN LN, JOPLIN, MO 64801-3084
(417) 782-6200
Mailing address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3347
(918) 488-6001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5883
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235178930
—
MO
05
—
1447412770
—
MO
05
—
1801077797
—
MO
01
—
26-8535
RH MEDICARE
MO
01
—
26D0679044
CLIA
MO
01
—
26D0889777
CLIA
MO
01
—
597780303
RH MEDICAID
MO
01
—
P00849708
RR MEDICARE
MO
Enumeration date
11/19/2007
Last updated
06/04/2020
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