Basic Information
| Provider Information | |||||||||
| NPI: | 1033353388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4502 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741352536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186603400 | ||||||||
| FaxNumber: | 9186603410 | ||||||||
| Practice Location | |||||||||
| Address1: | 4502 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741352536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186603400 | ||||||||
| FaxNumber: | 9186603410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2009 | ||||||||
| LastUpdateDate: | 06/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | E-7476 | AR | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 5336 | OK | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 192225003 | 05 | AR | MEDICAID |