Healthcare Provider Details

I. General information

NPI: 1821701343
Provider Name (Legal Business Name): ROBERT HERBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 NW PASSAGE
OKLAHOMA CITY OK
73132-3414
US

IV. Provider business mailing address

12513 BENDING BROOK DR
PIEDMONT OK
73078-7854
US

V. Phone/Fax

Practice location:
  • Phone: 405-367-9646
  • Fax:
Mailing address:
  • Phone: 405-210-3582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1237
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: