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General NPI Number Information
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NPI Number | 1760633846
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Entity Type | Organization
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Legal Business Name | EVIDENT HEALTH SERVICES. LLC
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 3366 NW EXPRESSWAY STE. 520
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4444
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Country | US
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Telephone | 405-713-4990
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Fax |
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Provider Business Mailing Address
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Address Line | 3366 NW EXPRESSWAY STE. 520
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4444
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Country | US
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Telephone | 405-713-4990
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES A. BRYANT IV
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Credential | MD
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Telephone | 405-713-4990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 20972
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License Number State | OK
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