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NPI Code Detail

MEDICARE: BRIAN BLUTH MD

MEDICARE:   BRIAN  BLUTH  MD
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
1207Q00000XFamily Medicine Physician27013OK

General Provider Information

NPI Number : 1215043435
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN BLUTH MD
Provider Business Mailing Address
First Line : 1315 N WASHINGTON ST
Second Line :
City : WEATHERFORD
State : OK
Zip : 73096-2443
Country : US
Telephone Number : 580-772-2344
Fax Number : 580-772-2330
Provider Business Practice Location Address
First Line : 1315 N WASHINGTON ST
Second Line :
City : WEATHERFORD
State : OK
Zip : 73096-2443
Country : US
Telephone Number : 580-772-2344
Fax Number : 580-772-2330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 11/19/2018

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