Provider Demographics
NPI:1346245438
Name:OAKDEN, RICHARD WADE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WADE
Last Name:OAKDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-1690
Mailing Address - Country:US
Mailing Address - Phone:435-438-7280
Mailing Address - Fax:435-438-7210
Practice Address - Street 1:1059 N 100 W
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-1690
Practice Address - Country:US
Practice Address - Phone:435-438-7280
Practice Address - Fax:435-438-7210
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48605621205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4019Medicaid
UT005538405Medicare ID - Type Unspecified
UTD4019Medicaid