Individual
RANDOLPH CHARLES ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6465 S YALE AVE, SUITE 815, TULSA, OK 74136-7823
(918) 492-1001
(918) 492-4866
Mailing address
1200 S BELMONT AVE, OKMULGEE, OK 74447-6310
(918) 710-4260
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
11509
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100166740A
—
OK
Enumeration date
07/10/2006
Last updated
05/09/2017
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