Individual
ROBERT NIEBERGALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 W BOISE CIR STE 160, BROKEN ARROW, OK 74012-4932
(918) 994-9160
(918) 403-6306
Mailing address
800 W BOISE CIR STE 160, BROKEN ARROW, OK 74012-4932
(918) 994-9160
(918) 403-6306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13607
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100014070A
—
OK
01
—
800522535
MEDICARE GROUP PIN
OK
Enumeration date
03/14/2006
Last updated
09/20/2018
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