Healthcare Provider Details

I. General information

NPI: 1538177225
Provider Name (Legal Business Name): D BRENT TIPTON M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 N BROOKLINE AVE SUITE 530
OKLAHOMA CITY OK
73112-3623
US

IV. Provider business mailing address

PO BOX 973
NORMAN OK
73070-0973
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-6652
  • Fax: 405-604-6653
Mailing address:
  • Phone: 405-329-2390
  • Fax: 405-329-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number18762
License Number StateOK

VIII. Authorized Official

Name: MS. JOY A. COSTNER
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 405-329-2390