Basic Information
| Provider Information | |||||||||
| NPI: | 1861496275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAU | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 N HARVARD AVE STE E | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741154904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188326051 | ||||||||
| FaxNumber: | 9188326055 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W. BOISE CIRCLE STE. 160 | ||||||||
| Address2: | |||||||||
| City: | BROKEN ARROW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740124932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183796260 | ||||||||
| FaxNumber: | 9182933149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 04/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21264 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.