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General NPI Number Information
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NPI Number | 1659652576
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Entity Type | Organization
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Legal Business Name | JENNIFER B. ROBERTS, MD, PLLC
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 2413 PALMER CIR
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City | NORMAN
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State | OK
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Zip | 73069-6301
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Country | US
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Telephone | 405-310-3843
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Fax | 405-321-5348
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Provider Business Mailing Address
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Address Line | PO BOX 248855
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City | OKLAHOMA CITY
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State | OK
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Zip | 73124-8855
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Country | US
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Telephone | 405-310-3843
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Fax | 405-321-5348
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Authorized Official
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Title or Position | MD
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Name | JENNIFER ROBERTS
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Credential | MD
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Telephone | 405-310-3843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25719
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License Number State | OK
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