Provider Demographics
NPI:1023070356
Name:HERLIHY, RICHARD E (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:HERLIHY
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 1:4140 W MEMORIAL RD STE 611
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8300
Mailing Address - Country:US
Mailing Address - Phone:405-749-4288
Mailing Address - Fax:405-749-4287
Practice Address - Street 1:4140 W MEMORIAL RD
Practice Address - Street 2:SUITE 611
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8366
Practice Address - Country:US
Practice Address - Phone:405-749-4288
Practice Address - Fax:405-749-4287
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12710208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK202130641010OtherBC/BS
OK100088990AMedicaid
OKP00383953Medicare PIN
OKC95039Medicare UPIN
OK100088990AMedicaid
246705401Medicare PIN