Healthcare Provider Details

I. General information

NPI: 1790343085
Provider Name (Legal Business Name): BRANT BENNETT, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HEALTHPLEX PKWY # 102
NORMAN OK
73072-9738
US

IV. Provider business mailing address

305 SUMMIT CREST LN
NORMAN OK
73071-4083
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-6955
  • Fax:
Mailing address:
  • Phone: 405-924-0050
  • Fax: 405-293-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANT QUINN BENNETT
Title or Position: PHYSICIAN
Credential: MD
Phone: 405-924-0050