Provider Demographics
NPI: | 1780675082 |
---|---|
Name: | OSTEEN, ROBERT (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ROBERT |
Middle Name: | |
Last Name: | OSTEEN |
Suffix: | |
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: | DEPT 960339 |
Mailing Address - Street 2: | |
Mailing Address - City: | OKLAHOMA CITY |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 73196-0339 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 877-485-4474 |
Mailing Address - Fax: | 405-341-9217 |
Practice Address - Street 1: | 886 HIGHWAY 411 NORTH |
Practice Address - Street 2: | |
Practice Address - City: | ETOWAH |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37331-1912 |
Practice Address - Country: | US |
Practice Address - Phone: | 888-447-2450 |
Practice Address - Fax: | 405-341-9217 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-11-04 |
Last Update Date: | 2010-01-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 24118 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3092853 | Medicaid | |
TN | P00772057 | Other | RRMCARE THRU AMS |
TN | 1515579 | Medicaid | |
TN | 3092853 | Medicaid | |
TN | P00772057 | Other | RRMCARE THRU AMS |
TN | F79350 | Medicare UPIN | |
TN | 1515579 | Medicaid | |
TN | 302I057270 | Medicare PIN |