Healthcare Provider Details

I. General information

NPI: 1871840025
Provider Name (Legal Business Name): RICHARD ESCOE D. MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E I 44 SERVICE RD STE A
OKLAHOMA CITY OK
73111-7400
US

IV. Provider business mailing address

1401 E I 44 SERVICE RD STE A
OKLAHOMA CITY OK
73111-7400
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-9880
  • Fax: 405-285-9877
Mailing address:
  • Phone: 405-285-9880
  • Fax: 405-285-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: