MEDICARE: BRYAN JAMES BROWN

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	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1215434915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN JAMES BROWN

Provider Business Mailing Address
First Line	:	512 E OKLAHOMA ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-4832
Country	:	US
Telephone Number	:	918-770-6631
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 E OKLAHOMA ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-4832
Country	:	US
Telephone Number	:	918-770-6631
Fax Number	:

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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