Individual
DR. RANDALL WAYNE HENTHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 NE 13TH ST, OAC 200, OKLAHOMA CITY, OK 73104-5010
(405) 271-4351
(405) 271-8695
Mailing address
1122 NE 13TH ST, ORI 236, OKLAHOMA CITY, OK 73117-1039
(405) 271-1515
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
11470
OK
208VP0014X
Interventional Pain Medicine Physician
Primary
11470
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050080210
RAILROAD MEDICARE
OK
01
—
352500500
US DEPT OF LAOR/OWCP
—
01
—
731069171007
BLUE CROSS BLUE SHIELD
OK
01
—
731590295004
HUMANA MILITARY
OK
Enumeration date
08/22/2005
Last updated
08/13/2012
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