Organization
RANDALL W. HENTHORN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL WAYNE HENTHORN M.D. (PRESIDENT)
(405) 736-9331
Entity
Organization
Contact information
Practice address
520 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-5723
(405) 736-9331
(405) 736-0497
Mailing address
520 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-5723
(405) 736-9331
(405) 736-0497
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11470
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050080210
RAILROAD MEDICARE
OK
01
—
352500500
FEDERAL WORKERS COMP
—
01
—
731069171007
BLUE CROSS BLUE SHIELD
OK
Enumeration date
03/01/2007
Last updated
01/26/2010
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