Healthcare Provider Details

I. General information

NPI: 1629035480
Provider Name (Legal Business Name): RICHARD HAL O'DELL II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NW 56TH SUITE 206
OKLAHOMA CITY OK
73112-4426
US

IV. Provider business mailing address

3330 NW 56TH SUITE 206
OKLAHOMA CITY OK
73112-4426
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-4710
  • Fax: 405-945-4751
Mailing address:
  • Phone: 405-945-4710
  • Fax: 405-265-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number17921
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: