Provider Demographics
NPI:1679554737
Name:LLANDEROSOS, OSWALD (MD)
Entity type:Individual
Prefix:MR
First Name:OSWALD
Middle Name:
Last Name:LLANDEROSOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSVALDO
Other - Middle Name:R
Other - Last Name:LLAN DE ROSOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1553 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6621
Mailing Address - Country:US
Mailing Address - Phone:405-217-8500
Mailing Address - Fax:405-217-8501
Practice Address - Street 1:1553 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6621
Practice Address - Country:US
Practice Address - Phone:405-217-8500
Practice Address - Fax:405-217-8501
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11647207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100108050AMedicaid
C95185Medicare UPIN
247720101Medicare PIN