Healthcare Provider Details

I. General information

NPI: 1053749051
Provider Name (Legal Business Name): JAMES ROBERTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N LOTTIE AVE
OKLAHOMA CITY OK
73117-2051
US

IV. Provider business mailing address

1311 N LOTTIE AVE
OKLAHOMA CITY OK
73117-2051
US

V. Phone/Fax

Practice location:
  • Phone: 405-600-3074
  • Fax:
Mailing address:
  • Phone: 405-600-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: