Basic Information
| Provider Information | |||||||||
| NPI: | 1194894915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARCHER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4221 S WESTERN AVE STE 2010 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056445120 | ||||||||
| FaxNumber: | 4056445309 | ||||||||
| Practice Location | |||||||||
| Address1: | 4221 S WESTERN AVE STE 2010 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056445120 | ||||||||
| FaxNumber: | 4056445309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 1962 | OK | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.