MEDICARE: JAMES R BRIXEY DO PC

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	207Q00000X	Family Medicine Physician	1527	OK

General Provider Information

NPI Number	:	1528253366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES R BRIXEY DO PC

Provider Business Mailing Address
First Line	:	1500 E DOWNING ST
Second Line	:	STE 101
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-3354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 E DOWNING ST
Second Line	:	STE 101
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-3354
Country	:	US
Telephone Number	:	918-456-2549
Fax Number	:	918-456-3395

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES R BRIXEY
Credential	:	D.O.
Telephone Number	:	918-456-2549

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	10/21/2008

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