Provider Demographics
NPI:1780610725
Name:FRANCIS, PAUL ALEXANDER (PAC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALEXANDER
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 OLD 122 RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9497
Mailing Address - Country:US
Mailing Address - Phone:513-673-5125
Mailing Address - Fax:
Practice Address - Street 1:1493 OLD 122 RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9497
Practice Address - Country:US
Practice Address - Phone:513-673-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000934363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00625608Medicare PIN
Q69997Medicare UPIN
FRPA27021Medicare PIN
OHFRPA27022Medicare PIN