Individual
DR. RICHARD FREDERICK COSTELLO II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2224 NW 50TH ST, SUITE 276W, OKLAHOMA CITY, OK 73112-8046
(405) 858-2350
(405) 858-2365
Mailing address
2224 NW 50TH ST, SUITE 276W, OKLAHOMA CITY, OK 73112-8046
(405) 858-2350
(405) 858-2365
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
03844
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200075870A
—
OK
01
—
P00369403
RAILROAD MEDICARE
OK
01
—
P00379874
RAILROAD MEDICARE
OK
01
—
P00388318
RAILROAD MEDICARE
OK
01
—
P00427829
RAILROAD MEDICARE
OK
Enumeration date
05/09/2006
Last updated
04/12/2013
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