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General NPI Number Information
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NPI Number | 1487629556
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Entity Type | Individual
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Provider Name | BRIAN R BOGGS MD
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 4200 W MEMORIAL RD SUITE 610
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-9350
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Country | US
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Telephone | 405-749-7023
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Fax | 405-749-7024
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Provider Business Mailing Address
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Address Line | 4401 W MEMORIAL RD 140
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-1785
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Country | US
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Telephone | 405-752-3162
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Fax | 405-936-5211
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 13955
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 13955
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 13955
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License Number State | OK
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