Provider Demographics
NPI:1164490223
Name:RAHHAL, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:RAHHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6406 N SANTA FE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9117
Mailing Address - Country:US
Mailing Address - Phone:405-840-3793
Mailing Address - Fax:405-840-3794
Practice Address - Street 1:6406 N SANTA FE AVE STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9117
Practice Address - Country:US
Practice Address - Phone:405-840-3793
Practice Address - Fax:405-840-3794
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK163052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125670AMedicaid
OK100125670AMedicaid