MEDICARE: DR. BRAD A. MCINTOSH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	21254	OK

General Provider Information

NPI Number	:	1659373819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD A. MCINTOSH MD

Provider Business Mailing Address
First Line	:	3330 W OKMULGEE ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-5069
Country	:	US
Telephone Number	:	918-682-4318
Fax Number	:	918-682-0615

Provider Business Practice Location Address
First Line	:	3330 W OKMULGEE ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-5069
Country	:	US
Telephone Number	:	918-682-4318
Fax Number	:	918-682-0615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/23/2024

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