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NPI Code Detail

MEDICARE: DR. ROBERT WILLIAM RADER M.D., D.PH.

MEDICARE: DR. ROBERT WILLIAM RADER M.D., D.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician21263OK

General Provider Information

NPI Number : 1669406062
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT WILLIAM RADER M.D., D.PH.
Provider Business Mailing Address
First Line : PO BOX 268922
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73126-8922
Country : US
Telephone Number : 405-231-3857
Fax Number : 405-272-7977
Provider Business Practice Location Address
First Line : 1000 N LEE AVE
Second Line : RM 1921
City : OKLAHOMA CITY
State : OK
Zip : 73102-1036
Country : US
Telephone Number : 405-272-6406
Fax Number : 405-272-6075
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 10/19/2012

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