Provider Demographics
NPI:1801864558
Name:CASEY, RHONDA L (DO)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:CASEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 S HOUSTON AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9023
Mailing Address - Country:US
Mailing Address - Phone:918-382-4600
Mailing Address - Fax:918-382-3183
Practice Address - Street 1:717 S HOUSTON AVE FL 4
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9023
Practice Address - Country:US
Practice Address - Phone:918-382-4600
Practice Address - Fax:918-382-3183
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3452208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100107760CMedicaid
OKG99129Medicare UPIN
OK100107760CMedicaid