Provider Demographics
NPI:1548433345
Name:JACOB, PAUL BRIAN (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRIAN
Last Name:JACOB
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Gender:M
Credentials:DO
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Mailing Address - Street 1:9800 BROADWAY EXTENSION
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114
Mailing Address - Country:US
Mailing Address - Phone:405-424-5426
Mailing Address - Fax:405-424-5431
Practice Address - Street 1:9800 BROADWAY EXTENSION
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-424-5426
Practice Address - Fax:405-424-5431
Is Sole Proprietor?:No
Enumeration Date:2008-04-12
Last Update Date:2016-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH390200000X207X00000X
OK5494207XS0114X
OHOH-96382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic