Provider Demographics
NPI:1508865361
Name:HILL, RILEY MARK (MD)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:MARK
Last Name:HILL
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 1:6600 S YALE AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 S ELM PL
Practice Address - Street 2:SUITE 256
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7877
Practice Address - Country:US
Practice Address - Phone:918-449-3720
Practice Address - Fax:918-449-3725
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK15163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101230AMedicaid
OK100101230AMedicaid
D39203Medicare UPIN