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General NPI Number Information
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NPI Number | 1619465457
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Entity Type | Individual
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Provider Name | BRIAN PFENNINGER MBA, RDCS, RDMS
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Gender | Male
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 2805 S BRYANT AVE STE B
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City | EDMOND
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State | OK
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Zip | 73013-6158
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Country | US
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Telephone | 405-330-2225
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Fax | 405-832-1172
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Provider Business Mailing Address
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Address Line | 4808 NW 159TH ST
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City | EDMOND
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State | OK
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Zip | 73013-3220
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Country | US
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Telephone | 405-330-2225
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Fax | 405-832-1172
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 146528
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License Number State | OK
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