Healthcare Provider Details

I. General information

NPI: 1518339811
Provider Name (Legal Business Name): DORI RAYCOB NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SE FRANK PHILLIPS BLVD SUITE 300
BARTLESVILLE OK
74006
US

IV. Provider business mailing address

3400 SE FRANK PHILLIPS BLVD STE 300
BARTLESVILLE OK
74006
US

V. Phone/Fax

Practice location:
  • Phone: 832-477-0343
  • Fax:
Mailing address:
  • Phone: 918-331-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107244
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR0107244
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: