Provider Demographics
NPI:1629035480
Name:O'DELL, RICHARD HAL II (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HAL
Last Name:O'DELL
Suffix:II
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 1:3330 NW 56TH
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-945-4710
Mailing Address - Fax:405-265-6308
Practice Address - Street 1:3330 NW 56TH
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4426
Practice Address - Country:US
Practice Address - Phone:405-945-4710
Practice Address - Fax:405-945-4751
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK179212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100065450AMedicaid
OKP00415260OtherMEDICARE RR LLC
OKP00415260Medicare PIN
F09460Medicare UPIN
OK243727002Medicare PIN
OK100065450AMedicaid
OK246719306Medicare PIN
OK246719308Medicare PIN
OKP00449093Medicare PIN
OK246719307Medicare PIN