Healthcare Provider Details

I. General information

NPI: 1033353388
Provider Name (Legal Business Name): CHRISTOPHER LEE ROBERTSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E 41ST ST
TULSA OK
74135-2536
US

IV. Provider business mailing address

4502 E 41ST ST
TULSA OK
74135-2536
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3400
  • Fax: 918-660-3410
Mailing address:
  • Phone: 918-660-3400
  • Fax: 918-660-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-7476
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5336
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: