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General NPI Number Information
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NPI Number | 1225847056
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Entity Type | Organization
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Legal Business Name | ADVANCED ENT
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 411 STONE WOOD DR
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City | BROKEN ARROW
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State | OK
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Zip | 74012-1026
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Country | US
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Telephone | 918-924-5917
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Fax |
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Provider Business Mailing Address
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Address Line | 411 STONE WOOD DR
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City | BROKEN ARROW
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State | OK
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Zip | 74012-1026
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Country | US
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Telephone | 918-922-2368
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Fax | 918-922-2367
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BRADLEY RUSSELL MONS
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Credential | DO
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Telephone | 918-863-6275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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