Provider Demographics
NPI:1700911732
Name:RICHARD M. ALBERTSON, M.D., PLLC
Entity Type:Organization
Organization Name:RICHARD M. ALBERTSON, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:580-255-2122
Mailing Address - Street 1:1607 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1360
Mailing Address - Country:US
Mailing Address - Phone:580-255-2122
Mailing Address - Fax:580-255-9695
Practice Address - Street 1:1607 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1360
Practice Address - Country:US
Practice Address - Phone:580-255-2122
Practice Address - Fax:580-255-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20765208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45496780001OtherBLUE CROSS
OK100256970CMedicaid
020052445OtherRAILROAD MEDICARE
020052445OtherRAILROAD MEDICARE
020052445OtherRAILROAD MEDICARE
45496780001OtherBLUE CROSS