Healthcare Provider Details

I. General information

NPI: 1023167798
Provider Name (Legal Business Name): BRIAN ALAN LINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD SUITE 518
OKLAHOMA CITY OK
73120-8366
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 405-749-4230
  • Fax: 405-749-4228
Mailing address:
  • Phone: 405-755-1515
  • Fax: 405-936-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number23047
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: