Healthcare Provider Details

I. General information

NPI: 1619316775
Provider Name (Legal Business Name): JASON ANDREW BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 HEALTH CENTER PKWY STE 100
YUKON OK
73099-6396
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 405-717-5400
  • Fax: 405-717-5441
Mailing address:
  • Phone: 405-717-5400
  • Fax: 405-717-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMDR-20401
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number37120
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37120
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: