Healthcare Provider Details

I. General information

NPI: 1558327429
Provider Name (Legal Business Name): BRYAN R GRIEME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE 4TH FLOOR
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

1000 N LEE AVE 4TH FLOOR
OKLAHOMA CITY OK
73102-1036
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-7699
  • Fax: 405-272-7937
Mailing address:
  • Phone: 405-272-7699
  • Fax: 405-272-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number24843
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: