Healthcare Provider Details

I. General information

NPI: 1396945564
Provider Name (Legal Business Name): DOUGLAS W RICHMOND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5795 S ELM PL
BROKEN ARROW OK
74011-4893
US

IV. Provider business mailing address

11960 S 98TH EAST AVE
BIXBY OK
74008-2552
US

V. Phone/Fax

Practice location:
  • Phone: 918-716-5437
  • Fax:
Mailing address:
  • Phone: 918-369-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25821
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: