Individual
MRS. SALLY MARIE ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3400 W TECUMSEH RD STE 101, NORMAN, OK 73072-1810
(405) 360-6764
(405) 360-6769
Mailing address
3400 W TECUMSEH RD STE 101, NORMAN, OK 73072-1810
(405) 360-6764
(405) 360-6769
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1239
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200006210A
—
OK
01
—
970030418
RAILROAD MEDICARE
OK
Enumeration date
04/26/2006
Last updated
02/28/2014
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