Provider Demographics
NPI:1477677532
Name:ROCHELL, ROBERT DALE
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:ROCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 N HIGHWAY 81 STE 61
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1795
Mailing Address - Country:US
Mailing Address - Phone:580-252-8164
Mailing Address - Fax:580-255-1516
Practice Address - Street 1:1206 N HIGHWAY 81 STE 61
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1795
Practice Address - Country:US
Practice Address - Phone:580-252-8164
Practice Address - Fax:580-255-1516
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV208455331332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK208455331OtherFEIN
OK208455331OtherFEIN