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General NPI Number Information
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NPI Number | 1104263847
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Entity Type | Organization
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Legal Business Name | JARED M ROBERTS, MD, PLLC
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 1407 N PORTER AVE
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City | NORMAN
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State | OK
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Zip | 73071-6659
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Country | US
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Telephone | 405-329-4304
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Fax | 405-366-8993
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Provider Business Mailing Address
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Address Line | 1407 N PORTER AVE
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City | NORMAN
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State | OK
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Zip | 73071-6659
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Country | US
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Telephone | 405-329-4304
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Fax | 405-366-8993
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Authorized Official
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Title or Position | OWNER
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Name | DR. JARED M ROBERTS
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Credential | M.D.
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Telephone | 405-329-4304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 29763
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License Number State | OK
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