Healthcare Provider Details

I. General information

NPI: 1831202670
Provider Name (Legal Business Name): GUILLERMO ROBLES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N 14TH ST STE 203
PONCA CITY OK
74601-2039
US

IV. Provider business mailing address

1908 N 14TH ST STE 203
PONCA CITY OK
74601-2039
US

V. Phone/Fax

Practice location:
  • Phone: 580-718-4501
  • Fax: 580-718-4581
Mailing address:
  • Phone: 580-718-4501
  • Fax: 580-762-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA-2055-17
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberK0176
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7205
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: