Healthcare Provider Details

I. General information

NPI: 1255183356
Provider Name (Legal Business Name): BRADY LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BRYAN DR STE 201
DURANT OK
74701-2157
US

IV. Provider business mailing address

1400 BRYAN DR STE 201
DURANT OK
74701-2157
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-5500
  • Fax: 580-924-1991
Mailing address:
  • Phone: 580-924-5500
  • Fax: 580-924-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9107
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: