Provider Demographics
NPI:1053301507
Name:PETRONE, ROBERT LOUIS (PHD, MPH, PA-C)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:PETRONE
Suffix:
Gender:M
Credentials:PHD, MPH, PA-C
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Mailing Address - Street 1:1400 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6347
Mailing Address - Country:US
Mailing Address - Phone:405-366-0978
Mailing Address - Fax:
Practice Address - Street 1:550 POPE AVE
Practice Address - Street 2:GENTRY CLINIC MAHC
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-6601
Practice Address - Fax:913-684-6128
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPA322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant