Healthcare Provider Details

I. General information

NPI: 1437189933
Provider Name (Legal Business Name): BRYAN RICHARD WHITLOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 E 46TH ST
TULSA OK
74135
US

IV. Provider business mailing address

3319 E 46TH ST
TULSA OK
74135
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-5438
  • Fax: 918-743-0664
Mailing address:
  • Phone: 918-743-5438
  • Fax: 918-743-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number18447
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: