Provider Demographics
NPI:1518025964
Name:RILEY, DONALD LEON II (DO)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEON
Last Name:RILEY
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COMMUNITY HEALTH DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EUFALA
Mailing Address - State:OK
Mailing Address - Zip Code:74432
Mailing Address - Country:US
Mailing Address - Phone:918-689-9130
Mailing Address - Fax:
Practice Address - Street 1:100 COMMUNITY HEALTH DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:EUFALA
Practice Address - State:OK
Practice Address - Zip Code:74432
Practice Address - Country:US
Practice Address - Phone:918-689-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100103320DMedicaid
OKP00747370OtherMEDICARE RAILROAD
OKP00747370OtherMEDICARE RAILROAD
G97796Medicare UPIN