Individual
GRANT K MAULDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3048 SW 89TH ST, SUITE A, OKLAHOMA CITY, OK 73159-6385
(405) 755-9350
(405) 775-9360
Mailing address
PO BOX 108835, OKLAHOMA CITY, OK 73101-8835
(405) 755-9350
(405) 775-9360
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
13115
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080027069
RAILROAD MEDICARE
OK
05
—
100111630A
—
OK
01
—
141657700
DEPT OF LABOR
OK
01
—
4351614
AETNA
OK
Enumeration date
09/30/2005
Last updated
07/26/2013
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