Provider Demographics
NPI:1336223593
Name:HARRIS, RICHARD SATIANTY (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SATIANTY
Last Name:HARRIS
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73062-0338
Mailing Address - Country:US
Mailing Address - Phone:405-249-3813
Mailing Address - Fax:
Practice Address - Street 1:US HWY 9 WEST
Practice Address - Street 2:CARNEGIE INDIAN HEALTH CLINIC
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK125764Medicare UPIN