Healthcare Provider Details

I. General information

NPI: 1912231713
Provider Name (Legal Business Name): TODD BRANNON H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W MEMORIAL RD SUITE 259A
OKLAHOMA CITY OK
73134-8039
US

IV. Provider business mailing address

2501 W MEMORIAL RD SUITE 259A
OKLAHOMA CITY OK
73134-8039
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-6557
  • Fax:
Mailing address:
  • Phone: 405-755-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number841
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: