Healthcare Provider Details

I. General information

NPI: 1164070314
Provider Name (Legal Business Name): LOWELL JAMES ROBERTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST FL 11 STE 1102
TULSA OK
74135-5018
US

IV. Provider business mailing address

5310 E 31ST ST FL 13
TULSA OK
74135-5018
US

V. Phone/Fax

Practice location:
  • Phone: 918-561-1890
  • Fax: 918-561-1889
Mailing address:
  • Phone: 918-561-5701
  • Fax: 918-561-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number17290
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: