=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790984938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK P BRITT, MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2007
-----------------------------------------------------
Last Update Date | 12/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10502 N 110TH EAST AVE STE 334
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-6655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-376-8578
-----------------------------------------------------
Fax | 918-376-8579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | DEPT 2108
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74182-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-622-8513
-----------------------------------------------------
Fax | 918-622-8552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | MARK P BRITT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 918-376-8578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 16604
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------