Healthcare Provider Details

I. General information

NPI: 1245074491
Provider Name (Legal Business Name): CAMERON MICHAEL O'BRIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BRYAN DR STE 201
DURANT OK
74701-2157
US

IV. Provider business mailing address

5651 36TH AVE NE
NORMAN OK
73026-7804
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-5500
  • Fax: 580-924-1991
Mailing address:
  • Phone: 405-639-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: