Provider Demographics
NPI:1972545820
Name:HELTON, RICHARD J
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:HELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:COALGATE
Mailing Address - State:OK
Mailing Address - Zip Code:74538-0345
Mailing Address - Country:US
Mailing Address - Phone:580-927-2334
Mailing Address - Fax:580-927-9941
Practice Address - Street 1:108 W OHIO
Practice Address - Street 2:
Practice Address - City:COALGATE
Practice Address - State:OK
Practice Address - Zip Code:74538-2827
Practice Address - Country:US
Practice Address - Phone:580-927-2334
Practice Address - Fax:580-927-9941
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2096207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100741130BMedicaid
OK100741130CMedicaid
OK100741130AMedicaid
OK100089840AMedicaid
OK100741130BMedicaid
OK100089840AMedicaid
OK373823Medicare Oscar/Certification