MEDICARE: DR. PETER ALAN RAO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	24115	OK

General Provider Information

NPI Number	:	1710958483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ALAN RAO MD

Provider Business Mailing Address
First Line	:	5544 S LEWIS AVE STE 600
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7105
Country	:	US
Telephone Number	:	918-747-4900
Fax Number	:	918-747-4903

Provider Business Practice Location Address
First Line	:	5544 S LEWIS AVE STE 600
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7105
Country	:	US
Telephone Number	:	918-747-4900
Fax Number	:	918-747-4903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/21/2022

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