Healthcare Provider Details

I. General information

NPI: 1043839012
Provider Name (Legal Business Name): TRAVIS JOHN BRACHTENBACH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12697 E 51ST ST
TULSA OK
74146-6236
US

IV. Provider business mailing address

12697 E 51ST ST
TULSA OK
74146-6236
US

V. Phone/Fax

Practice location:
  • Phone: 918-505-3200
  • Fax:
Mailing address:
  • Phone: 918-505-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number7294
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberU3795
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: