Provider Demographics
NPI:1639141724
Name:WESTENHAVER, RITA (DO)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:WESTENHAVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8115 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4331
Mailing Address - Country:US
Mailing Address - Phone:918-254-6315
Mailing Address - Fax:918-403-6315
Practice Address - Street 1:8115 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4331
Practice Address - Country:US
Practice Address - Phone:918-254-6315
Practice Address - Fax:918-403-6315
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2731207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100710600EOtherGROUP OK MEDICAID
731438253OtherGROUP MEDICARE
OK2731OtherOKLAHOMA MEDICAL LICENSE
KS05-34090OtherLICENSE
OK100102280AMedicaid
731438253-007OtherGROUP BCBS
TXJ0677OtherTEXAS MEDICAL LICENSE NUM
KS05-34090OtherLICENSE
731438253-007OtherGROUP BCBS