MEDICARE: DR. ADDISON PIERCE ROBERTS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	7585	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326494717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADDISON PIERCE ROBERTS D.O.

Provider Business Mailing Address
First Line	:	2448 E 81ST ST STE 1100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-4205
Country	:	US
Telephone Number	:	918-505-3400
Fax Number	:	918-508-7070

Provider Business Practice Location Address
First Line	:	2448 E 81ST ST STE 1100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-4205
Country	:	US
Telephone Number	:	918-505-3400
Fax Number	:	918-508-7070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	07/18/2025

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