Robert Eugene Vandiver II, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

527 Issued in OK

Practice address

139 E Main St
Wilburton, OK 74578-4229

Phone

(918) 465-5727

Fax

(918) 465-3311

NPI assigned

Feb 15, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hussains Family Practice RHC

  dba Hussains Family Practice

  • Adult Health Nurse Practitioner
  • Wilburton, OK
  • NPI 1407971492
  NPD (past)
• R E F M Emergency Services

  • Emergency Care Clinic/Center
  • Hugo, OK
  • NPI 1194716530
  NPD (past)
• The Rogers Clinic

  • Family Medicine Physician
  • McAlester, OK
  • NPI 1548315971
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194825600000",
    "number": "1417090770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 E MAIN ST",
            "city": "WILBURTON",
            "state": "OK",
            "postal_code": "745784229",
            "telephone_number": "918-465-5727",
            "fax_number": "918-465-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 E MAIN ST",
            "city": "WILBURTON",
            "state": "OK",
            "postal_code": "745784229",
            "telephone_number": "918-465-5727",
            "fax_number": "918-465-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDIVER",
        "first_name": "ROBERT",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1417090770",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tidwell Healthcare, LLC (Tidwell Living Center)
• Darren Tidwell, DPH
• Crystal Renee Toland
• Misty D Tom
• Ricardo Mariano Valbuena, MD
• Veritas Properties LLC (Main Street Drug)
• Veritas Properties LLC (Main Street Drug)
• Caleb Seth Vinson, MS LPC
• Zackary Vinson
• Talisa Walker

• Physician Assistant in Wilburton, OK
• Providers in Wilburton, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.