Provider Demographics
NPI:1841326568
Name:W RICHARD LOERKE
Entity type:Organization
Organization Name:W RICHARD LOERKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LOERKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-749-3323
Mailing Address - Street 1:6966 S UTICA AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3903
Mailing Address - Country:US
Mailing Address - Phone:918-493-9405
Mailing Address - Fax:
Practice Address - Street 1:6966 S UTICA AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3903
Practice Address - Country:US
Practice Address - Phone:918-492-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE09795Medicare UPIN