Provider Demographics
NPI:1871799619
Name:ROBERTS, JENNIFER CAROL BARNES (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROL BARNES
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 248855 DEPT 55
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8855
Mailing Address - Country:US
Mailing Address - Phone:405-310-3843
Mailing Address - Fax:405-321-5348
Practice Address - Street 1:2413 PALMER CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6301
Practice Address - Country:US
Practice Address - Phone:405-310-3843
Practice Address - Fax:405-321-5348
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK25719207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology