Provider Demographics
NPI:1780630178
Name:TICER, RICHARD KENT (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENT
Last Name:TICER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9543 E 81ST ST
Mailing Address - Street 2:APT 603
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8110
Mailing Address - Country:US
Mailing Address - Phone:918-994-7134
Mailing Address - Fax:
Practice Address - Street 1:10109 E 79TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4564
Practice Address - Country:US
Practice Address - Phone:918-286-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2672207L00000X
OH34-004298T207L00000X
OK2402207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0799695Medicaid
AR0799695Medicaid
F03440Medicare UPIN