Provider Demographics
NPI:1831157973
Name:WORKMAN, RUSSELL L (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:L
Last Name:WORKMAN
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 1:3500 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2411
Mailing Address - Country:US
Mailing Address - Phone:918-832-6049
Mailing Address - Fax:918-832-6055
Practice Address - Street 1:3100 MEDICAL PKWY
Practice Address - Street 2:STE 100
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-1088
Practice Address - Country:US
Practice Address - Phone:918-341-1000
Practice Address - Fax:918-293-3141
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18552207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100045760BMedicaid
OK24H620521Medicare PIN
OK930085386Medicare PIN
OK24H619015Medicare PIN
OK100045760BMedicaid
OKF08586Medicare UPIN
OK24M802202Medicare PIN