Healthcare Provider Details

I. General information

NPI: 1245656834
Provider Name (Legal Business Name): JONATHAN ROBINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST
TULSA OK
74127-9020
US

IV. Provider business mailing address

5310 E 31ST ST STE 13
TULSA OK
74135-5013
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-5922
  • Fax:
Mailing address:
  • Phone: 918-561-5701
  • Fax: 918-561-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5804
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: