Provider Demographics
NPI:1710085329
Name:DORL, RICHARD EUGENE (DPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EUGENE
Last Name:DORL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 EAST GLENCOE ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:OK
Mailing Address - Zip Code:74032
Mailing Address - Country:US
Mailing Address - Phone:580-669-1112
Mailing Address - Fax:
Practice Address - Street 1:328 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-6607
Practice Address - Country:US
Practice Address - Phone:580-336-2136
Practice Address - Fax:580-336-9445
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10453OtherSTATE LICENSE