Healthcare Provider Details

I. General information

NPI: 1982976742
Provider Name (Legal Business Name): RICHARD ZIELINSKI MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W 3RD ST
WATONGA OK
73772
US

IV. Provider business mailing address

712 W 3RD ST
WATONGA OK
73772
US

V. Phone/Fax

Practice location:
  • Phone: 405-788-8883
  • Fax:
Mailing address:
  • Phone: 405-788-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number18795
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number18795
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18795
License Number StateOK

VIII. Authorized Official

Name: JERI LYNN GARRISON
Title or Position: DIRECTOR
Credential: MS
Phone: 405-788-8883