MEDICARE: DR. RICHARD JENE ALLGOOD M.D.

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
1	2086S0129X	Vascular Surgery Physician	8312	OK

General Provider Information

NPI Number	:	1689678245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JENE ALLGOOD M.D.

Provider Business Mailing Address
First Line	:	5404 SW LEE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-9521
Country	:	US
Telephone Number	:	580-536-7528
Fax Number	:	580-536-3571

Provider Business Practice Location Address
First Line	:	5404 SW LEE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-9521
Country	:	US
Telephone Number	:	580-536-7528
Fax Number	:	580-536-3571

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/08/2007

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