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General NPI Number Information
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NPI Number | 1467785204
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Entity Type | Organization
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Legal Business Name | BRETT D ABERNETHY MD PLLC
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 604 S CLASSEN AVE SUITE C
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City | MOORE
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State | OK
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Zip | 73160-5401
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Country | US
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Telephone | 405-799-0900
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Fax | 405-799-0902
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Provider Business Mailing Address
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Address Line | PO BOX 7593
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City | MOORE
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State | OK
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Zip | 73153-1593
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Country | US
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Telephone | 405-799-0900
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Fax | 405-799-0902
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRETT D ABERNETHY
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Credential | M.D.
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Telephone | 405-799-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 25259
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License Number State | OK
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