Provider Demographics
NPI:1588656292
Name:RICHARDS, WENDELL L (DO)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 258884
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-8884
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-272-7977
Practice Address - Street 1:114 N HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-1200
Practice Address - Country:US
Practice Address - Phone:405-258-2500
Practice Address - Fax:405-258-3053
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243620902Medicare PIN