Provider Demographics
NPI:1568457331
Name:BRITTINGHAM, RICHARD T (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:BRITTINGHAM
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 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:
Practice Address - Street 1:3201 W GORE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-353-6760
Practice Address - Fax:580-248-3760
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100031940AMedicaid
OK110152906OtherRAILROAD MEDICARE
125308600OtherDOL
OK5692307OtherAETNA
OK110152906OtherRAILROAD MEDICARE
OK$$$$$$$$$POtherMEDICARE ID