Healthcare Provider Details

I. General information

NPI: 1588656292
Provider Name (Legal Business Name): WENDELL L RICHARDS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N HIGHWAY 18
CHANDLER OK
74834-1200
US

IV. Provider business mailing address

PO BOX 258884
OKLAHOMA CITY OK
73125-8884
US

V. Phone/Fax

Practice location:
  • Phone: 405-258-2500
  • Fax: 405-258-3053
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2298
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: