Basic Information
| Provider Information | |||||||||
| NPI: | 1295727089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLUSQUELLEC | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 N PORTER AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053290121 | ||||||||
| FaxNumber: | 4052926099 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 N PORTER AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053290121 | ||||||||
| FaxNumber: | 4052926099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 19357 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110111738 | 01 | OK | RAILROAD MEDICARE | OTHER | 4645705 | 01 | OK | AETNA EDI | OTHER | 100083760A | 05 | OK | MEDICAID |