Healthcare Provider Details

I. General information

NPI: 1821072570
Provider Name (Legal Business Name): RICK L. ROBBINS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 EAST REDWOOD
SALLISAW OK
74955
US

IV. Provider business mailing address

511 EAST REDWOOD
SALLISAW OK
74955
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-9176
  • Fax:
Mailing address:
  • Phone: 918-775-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1851
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: