Provider Demographics
NPI:1184725764
Name:RICHARDS, DANELLE M (MD)
Entity type:Individual
Prefix:DR
First Name:DANELLE
Middle Name:M
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N CZECH HALL RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7897
Mailing Address - Country:US
Mailing Address - Phone:405-494-8600
Mailing Address - Fax:405-494-8567
Practice Address - Street 1:709 N CZECH HALL RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7897
Practice Address - Country:US
Practice Address - Phone:405-494-8600
Practice Address - Fax:405-494-8567
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103509207P00000X
FLME151874207P00000X
OK41658207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207728932Medicaid
FL118009500Medicaid
AR81323OtherBLUE CROSS ARKANSAS
MOP00187234Medicare ID - Type UnspecifiedMEDICARE RAILROAD CARRIER
MO207728932Medicaid