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General NPI Number Information
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NPI Number | 1780155945
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Entity Type | Individual
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Provider Name | BRENT BRANHAM
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Gender | Male
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 11601 W STANLEY DRAPER DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73165-6503
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Country | US
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Telephone | 405-802-0694
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 LINWOOD BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-2628
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Country | US
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Telephone | 405-232-1864
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Fax | 405-799-7528
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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