Healthcare Provider Details

I. General information

NPI: 1134336373
Provider Name (Legal Business Name): BRADLEY RUSSELL MONS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 STONE WOOD DR
BROKEN ARROW OK
74012-1026
US

IV. Provider business mailing address

411 STONE WOOD DR
BROKEN ARROW OK
74012-1026
US

V. Phone/Fax

Practice location:
  • Phone: 918-924-6275
  • Fax: 918-518-7563
Mailing address:
  • Phone: 918-922-2368
  • Fax: 918-922-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number57565
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number57565
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5413
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberOS014959
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: