Provider Demographics
NPI:1578523189
Name:REUST, RANDALL S (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
Last Name:REUST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1400 E DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3324
Mailing Address - Country:US
Mailing Address - Phone:918-456-0641
Mailing Address - Fax:918-458-0954
Practice Address - Street 1:1400 E DOWNING ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3324
Practice Address - Country:US
Practice Address - Phone:918-456-0641
Practice Address - Fax:918-458-0954
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3285207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100850750BMedicaid
OK100850750BMedicaid
OK249301601Medicare ID - Type Unspecified