Provider Demographics
NPI:1326293499
Name:ROBERTS, COREY LEE
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 5TH ST STE 720
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-4261
Mailing Address - Country:US
Mailing Address - Phone:918-588-8411
Mailing Address - Fax:918-582-4328
Practice Address - Street 1:111 W 5TH ST STE 720
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-4261
Practice Address - Country:US
Practice Address - Phone:918-588-8411
Practice Address - Fax:918-582-4328
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator