Provider Demographics
NPI:1346213253
Name:BLOCK, ROBERT WALTER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:BLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3401
Mailing Address - Fax:918-660-3410
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:2ND FLOOR, STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4300
Practice Address - Fax:918-660-3410
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK10605208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics