=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598760712
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERNARD N ROBINOWITZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 08/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9245 S MINGO RD SUITE 335
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-5793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-492-8980
-----------------------------------------------------
Fax | 918-495-0607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9245 S MINGO RD SUITE 335
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-5793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-492-8980
-----------------------------------------------------
Fax | 918-495-0607
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 10381
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------