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NPI Code Detail

MEDICARE: RICHARD CORNELIUS JR.

MEDICARE: RICHARD CORNELIUS JR.
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
1231H00000XAudiologistOK

General Provider Information

NPI Number : 1891627956
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD CORNELIUS JR.
Provider Business Mailing Address
First Line : 11500 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-4625
Country : US
Telephone Number : 405-548-4300
Fax Number : 405-548-4350
Provider Business Practice Location Address
First Line : 11500 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-4625
Country : US
Telephone Number : 405-548-4300
Fax Number : 405-548-4350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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