Provider Demographics
NPI:1669868162
Name:CRUM, ROBERT WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WALTER
Last Name:CRUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EVERETT DR STE 2320
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5047
Mailing Address - Country:US
Mailing Address - Phone:405-271-5922
Mailing Address - Fax:
Practice Address - Street 1:1200 EVERETT DR STE 2320
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5047
Practice Address - Country:US
Practice Address - Phone:405-271-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK416572086S0120X
NY317390208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program