Healthcare Provider Details

I. General information

NPI: 1023070356
Provider Name (Legal Business Name): RICHARD E HERLIHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD SUITE 611
OKLAHOMA CITY OK
73120-8366
US

IV. Provider business mailing address

4140 W MEMORIAL RD STE 611
OKLAHOMA CITY OK
73120-8300
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-4288
  • Fax: 405-749-4287
Mailing address:
  • Phone: 405-749-4288
  • Fax: 405-749-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number12710
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: