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General NPI Number Information
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NPI Number | 1326048273
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Entity Type | Individual
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Provider Name | MARK BRADLEY EDMONDS MD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6839 S CANTON AVE
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City | TULSA
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State | OK
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Zip | 74136-3402
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Country | US
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Telephone | 918-494-0612
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Fax | 918-481-5170
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Provider Business Mailing Address
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Address Line | 7140 OAK FAIRWAY
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City | TULSA
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State | OK
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Zip | 74131-3461
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Country | US
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Telephone | 918-446-3982
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Fax | 918-446-8054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 17639
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License Number State | OK
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