Healthcare Provider Details

I. General information

NPI: 1619954682
Provider Name (Legal Business Name): BRIAN JOACHIMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 HARDCASTLE BLVD
PURCELL OK
73080-8233
US

IV. Provider business mailing address

1921 STONECIPHER DR
ADA OK
74820-3439
US

V. Phone/Fax

Practice location:
  • Phone: 405-527-4700
  • Fax: 580-272-5711
Mailing address:
  • Phone: 580-436-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21562
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: