Healthcare Provider Details

I. General information

NPI: 1033343025
Provider Name (Legal Business Name): BRENT WURFEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S YALE AVE
TULSA OK
74136-3326
US

IV. Provider business mailing address

6655 S YALE AVE
TULSA OK
74136-3326
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-5075
  • Fax: 918-502-5095
Mailing address:
  • Phone: 918-502-5075
  • Fax: 918-502-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27243
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: