Healthcare Provider Details

I. General information

NPI: 1457350142
Provider Name (Legal Business Name): ROBERT LOUIS ANDERSON C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 S MEMORIAL DR SUITE 104
TULSA OK
74133-1933
US

IV. Provider business mailing address

5 PATRICIA PL
MCALESTER OK
74501-7770
US

V. Phone/Fax

Practice location:
  • Phone: 918-252-2020
  • Fax: 918-307-1983
Mailing address:
  • Phone: 918-470-9556
  • Fax: 918-493-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0031375
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: