Healthcare Provider Details

I. General information

NPI: 1073512711
Provider Name (Legal Business Name): RANDEL DEAN ESTEP DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 W RENO AVE STE 500
OKLAHOMA CITY OK
73127-6346
US

IV. Provider business mailing address

9600 BROADWAY EXT
OKLAHOMA CITY OK
73114-7408
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-9250
  • Fax: 405-943-0742
Mailing address:
  • Phone: 405-230-9000
  • Fax: 405-230-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number00757960
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: