Basic Information
| Provider Information | |||||||||
| NPI: | 1396760302 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | FREMONT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 S. UTICA AVE. | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185792590 | ||||||||
| FaxNumber: | 9185792599 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 S. UTICA AVE. | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185792590 | ||||||||
| FaxNumber: | 9185792599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 05/06/2014 | ||||||||
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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 | 207RR0500X | 14764 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 100790180A | 05 | OK | MEDICAID |