Basic Information
| Provider Information | |||||||||
| NPI: | 1780675082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSTEEN | ||||||||
| FirstName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 960339 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731960339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774854474 | ||||||||
| FaxNumber: | 4053419217 | ||||||||
| Practice Location | |||||||||
| Address1: | 886 HIGHWAY 411 NORTH | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373311912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884472450 | ||||||||
| FaxNumber: | 4053419217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 24118 | TN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 3092853 | 05 | TN | MEDICAID | P00772057 | 01 | TN | RRMCARE THRU AMS | OTHER | 1515579 | 05 | TN | MEDICAID |