Healthcare Provider Details

I. General information

NPI: 1669932158
Provider Name (Legal Business Name): ROBERT JAMES KERLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7328 NW 115TH ST
OKLAHOMA CITY OK
73162-2709
US

IV. Provider business mailing address

7328 NW 115TH ST
OKLAHOMA CITY OK
73162-2709
US

V. Phone/Fax

Practice location:
  • Phone: 405-626-1944
  • Fax:
Mailing address:
  • Phone: 405-626-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: