Provider Demographics
NPI:1831202670
Name:ROBLES, GUILLERMO (DO)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:ROBLES
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 1:1908 N 14TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2039
Mailing Address - Country:US
Mailing Address - Phone:580-718-4501
Mailing Address - Fax:580-762-3825
Practice Address - Street 1:1908 N 14TH ST STE 203
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2039
Practice Address - Country:US
Practice Address - Phone:580-718-4501
Practice Address - Fax:580-718-4581
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2055-17207V00000X
TXK0176207V00000X
OK7205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156079901Medicaid
TX8A3258OtherBCBS
TX160059547OtherRAILROAD MEDICARE PIN
TXH77625Medicare UPIN
TX8A3258Medicare PIN