Healthcare Provider Details

I. General information

NPI: 1043127517
Provider Name (Legal Business Name): BRADY GAGE DOBYNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 ELKS LODGE RD
PAWHUSKA OK
74056-6542
US

IV. Provider business mailing address

473 ELKS LODGE RD
PAWHUSKA OK
74056-6542
US

V. Phone/Fax

Practice location:
  • Phone: 539-212-2499
  • Fax: 539-212-2648
Mailing address:
  • Phone: 539-212-2499
  • Fax: 539-212-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: