Healthcare Provider Details

I. General information

NPI: 1497774293
Provider Name (Legal Business Name): BRENT A. MEFFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD ER DEPT.
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE 140
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-1515
  • Fax: 405-749-4561
Mailing address:
  • Phone: 405-752-3162
  • Fax: 405-936-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27166
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25486
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: