Provider Demographics
NPI: | 1841289196 |
---|---|
Name: | REMONDINO, ROBERT L (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | ROBERT |
Middle Name: | L |
Last Name: | REMONDINO |
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: | 14100 PARKWAY COMMONS DR STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | OKLAHOMA CITY |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 73134-6036 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 405-748-3300 |
Mailing Address - Fax: | 405-748-2920 |
Practice Address - Street 1: | 14100 PARKWAY COMMONS DR STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | OKLAHOMA CITY |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73134-6036 |
Practice Address - Country: | US |
Practice Address - Phone: | 405-748-3300 |
Practice Address - Fax: | 405-748-2920 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-10-19 |
Last Update Date: | 2025-02-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 13247 | 174400000X, 207T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OK | 100070040A | Medicaid | |
OK | 100070040A | Medicaid | |
244419614 | Medicare ID - Type Unspecified |