Provider Demographics
NPI:1699753343
Name:ALLEN, RICHARD DARREN (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DARREN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-786-7200
Mailing Address - Fax:918-786-7212
Practice Address - Street 1:900 E 13TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2975
Practice Address - Country:US
Practice Address - Phone:918-786-7200
Practice Address - Fax:918-786-7212
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3647207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100747570AMedicaid
OK3647OtherLICENSE
OK200010200AMedicaid
P00242041Medicare PIN
H91753Medicare UPIN
OK100747570AMedicaid
244522301Medicare PIN
400522301Medicare PIN