MEDICARE: DR. BRENT NEAL HISEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	OK14408	OK

General Provider Information

NPI Number	:	1205826955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT NEAL HISEY M.D.

Provider Business Mailing Address
First Line	:	800 NW 9TH ST STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-7253
Country	:	US
Telephone Number	:	405-979-7875
Fax Number	:	405-979-7880

Provider Business Practice Location Address
First Line	:	800 NW 9TH ST STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-7253
Country	:	US
Telephone Number	:	405-979-7875
Fax Number	:	405-979-7880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	04/01/2022

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