LOWELL JAMES ROBERTSON (NPI# 1164070314) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164070314 |
| Entity Type | Individual |
| Full Name | LOWELL JAMES ROBERTSON |
| Credential | MD |
| Practice Address |
1111 W 17th St Tulsa OK 74107-1886 |
| Mailing Address |
4933 October Dr Edmond OK 73034-3451 |
| Practice Telephone | 4052050585 |
| Mailing Telephone | 4052050585 |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2019-08-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
17290 | OK | Allopathic & Osteopathic Physicians |
| Street Address |
1111 W 17TH ST |
| City | TULSA |
| State | OK |
| Zip Code | 74107-1886 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205162393 | Bruce Allen Benjamin | Specialist | 1111 W 17th St, Tulsa, OK 74107-1800 | 2009-10-23 |
| 1902423296 | Emily Madrak | Specialist/Technologist | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-07-02 |
| 1043839012 | Travis John Brachtenbach | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-04-10 |
| 1316575913 | Hallie Frederick | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-30 |
| 1285262899 | Jonathon Gurule | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-30 |
| 1194353086 | Dipa Puwar | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-28 |
| 1215564372 | Fernando Magana Herrera | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-26 |
| 1427685536 | Desiree C Lyon | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-26 |
| 1568099794 | Jennifer Cox | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-26 |
| 1487281705 | Mohammed Shaban | Student in an Organized Health Care Education/Training Program | 1111 W 17th St, Tulsa, OK 74107-1886 | 2020-03-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508493784 | Squareone Compassion Inc | Clinic/Center | 5323 South 65th West Avenue, Tulsa, OK 74107 | 2020-03-26 |
| 1649772476 | Lauren Michele Rogers | Student in an Organized Health Care Education/Training Program | 1111 W. 17th St., Barson 241, Tulsa, OK 74107 | 2018-03-07 |
| 1336641828 | Frank Patrick Goodman | Student in an Organized Health Care Education/Training Program | 2345 Sw Blvd, Tulsa, OK 74107 | 2018-03-01 |
| 1659827269 | Careatc - America Waste | Clinic/Center | 23322 Southwest Blvd, Tulsa, OK 74107 | 2016-09-01 |
| 1538530886 | Jeremy Michael Bowles | Pharmacist | 4227 Southwest Boulevard, Tulsa, OK 74107 | 2015-10-13 |
| 1760725865 | Nicholas Alexander | Student in an Organized Health Care Education/Training Program | 2345 Southwest Blvd., Osu Health Care Center, Tulsa, OK 74107 | 2013-03-27 |
| 1295095321 | Robert Steven Wedding | Counselor | 6033 S. 31 St. West Ave., Tulsa, OK 74107 | 2012-05-23 |
| 1295911451 | American Current Care P.a. | Clinic/Center | 5682 W Skelly Drive, Tulsa, OK 74107 | 2008-01-17 |
| 1821200072 | Leeca Jenkins | Counselor | 2007 W. 57th St, Tulsa, OK 74107 | 2007-05-03 |
| 1477670552 | Occupational Health Centers of The Southwest, P.a. | Clinic/Center | 5682 W. Skelly Drive, Tulsa, OK 74107 | 2007-03-23 |
| Find all providers in zip 74107 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588229033 | State of Oklahoma Osu Center for Health Sciences | Psychiatry & Neurology | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2019-05-09 |
| 1467659953 | Samuel Gene Martin | Psychiatry & Neurology | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2007-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497223846 | Mind and Body Medical Clinic | Psychiatry & Neurology | 2216 Nw 164th St Ste A, Edmond, OK 73013-9078 | 2018-11-04 |
| 1306134929 | Kimberlee Van Wilson | Psychiatry & Neurology | 4851 Integris Parkway, Edmond, OK 73034 | 2011-07-17 |
| 1316124605 | Jorg Johannes Pahl | Psychiatry & Neurology | 3909 N Classen Blvd Ste 200, Oklahoma City, OK 73118-2650 | 2008-01-29 |
| 1437683729 | F Clark Sauls, Md | Psychiatry & Neurology | 723 W Randolph Ave, Suite 6, Enid, OK 73701-3826 | 2017-04-13 |
| 1184981144 | Dustin O'leath Hayes | Psychiatry & Neurology | 817 S Elm Pl, Suite C, Broken Arrow, OK 74012-5369 | 2012-04-16 |
| 1942488986 | Jane Phillips Specialty Physicians | Psychiatry & Neurology | 226 Se Debell Ave, Bldg B, Bartlesville, OK 74006-2343 | 2008-02-01 |
| 1801966338 | Gayathri Dasharathy | Psychiatry & Neurology | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2006-11-09 |
| 1831281070 | Nicasio S Gutierrez Jr. | Psychiatry & Neurology | 909 Alameda St, Norman, OK 73071-5229 | 2006-09-28 |
| 1528168721 | Gita - Pujari II | Psychiatry & Neurology | 921 Ne 13th St, 116c, Oklahoma City, OK 73104-5007 | 2006-09-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.