Healthcare Provider Details

I. General information

NPI: 1750616884
Provider Name (Legal Business Name): TERRY BRADFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 E 51ST ST SUITE 400
TULSA OK
74135-7461
US

IV. Provider business mailing address

5525 E 51ST ST SUITE 400
TULSA OK
74135-7461
US

V. Phone/Fax

Practice location:
  • Phone: 918-388-6457
  • Fax: 918-388-6456
Mailing address:
  • Phone: 918-388-6457
  • Fax: 918-388-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: