Healthcare Provider Details

I. General information

NPI: 1932162021
Provider Name (Legal Business Name): ROBERT WARREN LETTON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 DEER CREEK RD
EDMOND OK
73003-9370
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 405-330-8403
  • Fax:
Mailing address:
  • Phone: 904-697-4127
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number20161
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: