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NPI Code Detail

MEDICARE: BRENDON DEAN MCCOLLOM DO

MEDICARE: BRENDON DEAN MCCOLLOM DO
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 Physician4315OK

General Provider Information

NPI Number : 1225256282
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDON DEAN MCCOLLOM DO
Provider Business Mailing Address
First Line : 5201 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-2004
Country : US
Telephone Number : 405-755-4050
Fax Number : 405-749-9566
Provider Business Practice Location Address
First Line : 5201 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-2004
Country : US
Telephone Number : 405-755-4050
Fax Number : 405-749-9566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 04/24/2015

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Directions to “ BRENDON DEAN MCCOLLOM DO” Practice Location

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