Healthcare Provider Details

I. General information

NPI: 1780675082
Provider Name (Legal Business Name): ROBERT OSTEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 HIGHWAY 411 NORTH
ETOWAH TN
37331-1912
US

IV. Provider business mailing address

DEPT 960339
OKLAHOMA CITY OK
73196-0339
US

V. Phone/Fax

Practice location:
  • Phone: 888-447-2450
  • Fax: 405-341-9217
Mailing address:
  • Phone: 877-485-4474
  • Fax: 405-341-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24118
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: