Provider Demographics
NPI:1588609606
Name:BREEDLOVE, ROBERT ALLAN (MD, FAAD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLAN
Last Name:BREEDLOVE
Suffix:
Gender:M
Credentials:MD, FAAD
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Mailing Address - Street 1:PO BOX 108809
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8809
Mailing Address - Country:US
Mailing Address - Phone:405-624-1077
Mailing Address - Fax:405-377-2273
Practice Address - Street 1:1604 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4207
Practice Address - Country:US
Practice Address - Phone:405-624-1077
Practice Address - Fax:405-377-2273
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK10612207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC35666Medicare UPIN