Individual
MR. ROBERT EUGENE VANDIVER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
139 E MAIN ST, WILBURTON, OK 74578-4229
(918) 465-5727
(918) 465-3311
Mailing address
139 E MAIN ST, WILBURTON, OK 74578-4229
(918) 465-5727
(918) 465-3311
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
527
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417090770
NPI
OK
Enumeration date
02/15/2007
Last updated
11/12/2007
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