Healthcare Provider Details

I. General information

NPI: 1013950740
Provider Name (Legal Business Name): RAJENDRA K. MOTWANI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9817 S WESTERN AVE
OKLAHOMA CITY OK
73139-2812
US

IV. Provider business mailing address

9817 S WESTERN AVE
OKLAHOMA CITY OK
73139-2812
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-4500
  • Fax: 405-632-7500
Mailing address:
  • Phone: 405-632-4500
  • Fax: 405-632-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number3478
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: