Provider Demographics
NPI:1871592931
Name:HALL, ROBIN B (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:B
Last Name:HALL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LEE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3410 W 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2732
Mailing Address - Country:US
Mailing Address - Phone:405-777-4955
Mailing Address - Fax:405-999-4775
Practice Address - Street 1:3410 W 19TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-2732
Practice Address - Country:US
Practice Address - Phone:405-777-4955
Practice Address - Fax:405-999-4775
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22870208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1122870Medicaid
373124Medicare ID - Type UnspecifiedHSP. PROVIDER #
37Z124Medicare ID - Type UnspecifiedHSP. PROVIDER #
OK1122870Medicaid