Healthcare Provider Details

I. General information

NPI: 1164609046
Provider Name (Legal Business Name): BRADLEY DALE PITTMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 15TH ST
WOODWARD OK
73801
US

IV. Provider business mailing address

1000 15TH ST
WOODWARD OK
73801
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-1236
  • Fax: 580-256-7500
Mailing address:
  • Phone: 580-256-1236
  • Fax: 580-256-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1696
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberPA1696
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: