Healthcare Provider Details

I. General information

NPI: 1568596583
Provider Name (Legal Business Name): ROBISON CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 WATTS ST
SAYRE OK
73662-1310
US

IV. Provider business mailing address

1415 WATTS ST
SAYRE OK
73662-1310
US

V. Phone/Fax

Practice location:
  • Phone: 580-928-2044
  • Fax: 580-928-5660
Mailing address:
  • Phone: 580-928-2044
  • Fax: 580-928-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2832
License Number StateOK

VIII. Authorized Official

Name: DR. MELVIN L ROBISON
Title or Position: OWNER
Credential: D.O.
Phone: 580-928-2044