Healthcare Provider Details

I. General information

NPI: 1053430512
Provider Name (Legal Business Name): GREGORY S. BROOKS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395200 W 2900 RD
OCHELATA OK
74051-2463
US

IV. Provider business mailing address

395200 W 2900 RD
OCHELATA OK
74051-2463
US

V. Phone/Fax

Practice location:
  • Phone: 918-535-6000
  • Fax:
Mailing address:
  • Phone: 918-535-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2578
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: