Provider Demographics
NPI:1215067822
Name:OATES, RANDALL BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:BENJAMIN
Last Name:OATES
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 1:4220 N.CROSSOVERRD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:70703
Mailing Address - Country:US
Mailing Address - Phone:479-251-1552
Mailing Address - Fax:479-251-8956
Practice Address - Street 1:4220 N.CROSSOVERRD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:70703
Practice Address - Country:US
Practice Address - Phone:479-251-1552
Practice Address - Fax:479-251-8956
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC-5922OtherARK STATE MEDICAL BOARD
ARC-5922OtherARK STATE MEDICAL BOARD