Provider Demographics
NPI:1780675082
Name:OSTEEN, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:OSTEEN
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:DEPT 960339
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0339
Mailing Address - Country:US
Mailing Address - Phone:877-485-4474
Mailing Address - Fax:405-341-9217
Practice Address - Street 1:886 HIGHWAY 411 NORTH
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1912
Practice Address - Country:US
Practice Address - Phone:888-447-2450
Practice Address - Fax:405-341-9217
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24118207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3092853Medicaid
TNP00772057OtherRRMCARE THRU AMS
TN1515579Medicaid
TN3092853Medicaid
TNP00772057OtherRRMCARE THRU AMS
TNF79350Medicare UPIN
TN1515579Medicaid
TN302I057270Medicare PIN