Basic Information
| Provider Information | |||||||||
| NPI: | 1285799825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | NEIL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2017 W I 35 FRONTAGE RD STE 190 | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730138559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053404937 | ||||||||
| FaxNumber: | 4053413078 | ||||||||
| Practice Location | |||||||||
| Address1: | 2017 W I 35 FRONTAGE RD STE 190 | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730138559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053404937 | ||||||||
| FaxNumber: | 4053413078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 03/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 24926 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 24926 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.