Individual
DR. ROBERT C WELLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 CHILDRENS AVE, OUCPB 5100, OKLAHOMA CITY, OK 73104-4637
(405) 271-2006
(405) 271-2263
Mailing address
1122 NE 13TH ST, ORI 236, OKLAHOMA CITY, OK 73117-1039
(405) 271-2006
(405) 271-2263
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
133112
NY
2080P0208X
Pediatric Infectious Diseases Physician
Primary
133112
NY
2080P0210X
Pediatric Nephrology Physician
133112
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010187604
UNIVERA
NY
01
—
000507730001
BC/BS
NY
01
—
000507730004
BC/BS
NY
01
—
000507730004
BC OF KANSAS
—
01
—
000507730005
BC/BS
NY
01
—
000507730005
BC OF KANSAS
—
05
—
00735837
—
NY
01
—
040426000753
FIDELIS
NY
01
—
080222000049
FIDELIS
NY
01
—
3905807
IHA
NY
Enumeration date
09/22/2006
Last updated
09/10/2012
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