Provider Demographics
NPI:1710979315
Name:ROBERTS, CHRISS B (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISS
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:1306 S.W. THIRD
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74477-0870
Mailing Address - Country:US
Mailing Address - Phone:918-485-4444
Mailing Address - Fax:918-485-7407
Practice Address - Street 1:1306 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-5518
Practice Address - Country:US
Practice Address - Phone:918-485-4444
Practice Address - Fax:918-485-7407
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100204950AMedicaid
OK$$$$$$$$$Medicare PIN
OK100204950AMedicaid