Provider Demographics
NPI:1043239411
Name:POLK, RICHARD ROSS (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROSS
Last Name:POLK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2840 E 51ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-1744
Mailing Address - Country:US
Mailing Address - Phone:918-749-0898
Mailing Address - Fax:918-749-0899
Practice Address - Street 1:2840 E 51ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-1744
Practice Address - Country:US
Practice Address - Phone:918-749-0898
Practice Address - Fax:918-749-0899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1343207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE15998Medicare UPIN