Individual
MR. GARY ROBERTS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6202 S LEWIS AVE STE H, TULSA, OK 74136-1064
(918) 428-8594
Mailing address
703 S LOUISVILLE AVE, TULSA, OK 74112-3921
(918) 428-8594
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
08/16/2012
Last updated
08/16/2012
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