Healthcare Provider Details

I. General information

NPI: 1104263847
Provider Name (Legal Business Name): JARED M ROBERTS, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 N PORTER AVE
NORMAN OK
73071-6659
US

IV. Provider business mailing address

1407 N PORTER AVE
NORMAN OK
73071-6659
US

V. Phone/Fax

Practice location:
  • Phone: 405-329-4304
  • Fax: 405-366-8993
Mailing address:
  • Phone: 405-329-4304
  • Fax: 405-366-8993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29763
License Number StateOK

VIII. Authorized Official

Name: DR. JARED M ROBERTS
Title or Position: OWNER
Credential: M.D.
Phone: 405-329-4304