Healthcare Provider Details

I. General information

NPI: 1962031591
Provider Name (Legal Business Name): DYLAN TYLER ROBERTS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HEALTHPLEX PKWY
NORMAN OK
73072-9749
US

IV. Provider business mailing address

1515 TOWER DR
MOORE OK
73160-6181
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-1000
  • Fax:
Mailing address:
  • Phone: 405-310-0836
  • Fax: 405-758-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7374
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number7374
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: