Healthcare Provider Details

I. General information

NPI: 1205157328
Provider Name (Legal Business Name): BRANDON PIERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 SW 89TH ST SUITE B
OKLAHOMA CITY OK
73159-6385
US

IV. Provider business mailing address

4200 WEST MEMORIAL RD SUITE 606
OKLAHOMA CITY OK
73120
US

V. Phone/Fax

Practice location:
  • Phone: 405-759-7600
  • Fax: 405-607-3575
Mailing address:
  • Phone: 405-755-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number27797
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: