Healthcare Provider Details

I. General information

NPI: 1174596514
Provider Name (Legal Business Name): BRIAN PEARCE BOBIER A.T.,C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W TECUMSEH RD SUITE 101
NORMAN OK
73072-1810
US

IV. Provider business mailing address

4201 JOHNSON FARMS DR
MUSTANG OK
73064-9256
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-6764
  • Fax:
Mailing address:
  • Phone: 405-441-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAT2846
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number386
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: