MEDICARE: DR. SHERRY LYNN ROLES D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4804	OK

General Provider Information

NPI Number	:	1649491762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERRY LYNN ROLES D.O.

Provider Business Mailing Address
First Line	:	PO BOX 11457
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4005
Country	:	US
Telephone Number	:	405-733-0313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5251
Country	:	US
Telephone Number	:	405-733-0313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/15/2013

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