Healthcare Provider Details

I. General information

NPI: 1609099605
Provider Name (Legal Business Name): ROBERT SCOTT GLADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BROADWAY EXT STE 200
OKLAHOMA CITY OK
73114-6323
US

IV. Provider business mailing address

9900 BROADWAY EXT STE 200
OKLAHOMA CITY OK
73114-6323
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-8833
  • Fax: 405-608-8818
Mailing address:
  • Phone: 405-608-8833
  • Fax: 405-608-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD036462
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number26967
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: