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DR. BRENT WADE DAVIS D.O.

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1619009859

Individual Registrant:
DR. BRENT WADE DAVIS D.O.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
315 W. 9 STREET  WELEETKA, OK 74880-0337 US
Tel: 405-786-2248  Fax: 405-786-2006

Contact information for business:
PO BOX 207  HENRYETTA, OK 74437-0207 US
Tel: 405-786-2248  Fax: 405-786-2006

Registration Information:
NPI: 1619009859
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
OK1913

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
100743630AOK05
100743630BOK05




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