Healthcare Provider Details

I. General information

NPI: 1629365085
Provider Name (Legal Business Name): E BRADLEY GARBER, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 S UTICA AVE
TULSA OK
74104-5336
US

IV. Provider business mailing address

1784 S UTICA AVE
TULSA OK
74104-5336
US

V. Phone/Fax

Practice location:
  • Phone: 918-745-2117
  • Fax: 918-745-2178
Mailing address:
  • Phone: 918-745-2117
  • Fax: 918-745-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number15059
License Number StateOK

VIII. Authorized Official

Name: DR. EUGENE BRADLEY GARBER
Title or Position: P.C.
Credential: M.D.
Phone: 918-745-2117