Provider Demographics
NPI:1003991787
Name:DR JOSEPH CLIFTON BROOME PC
Entity Type:Organization
Organization Name:DR JOSEPH CLIFTON BROOME PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-787-4915
Mailing Address - Street 1:RR 1 BOX 122B
Mailing Address - Street 2:
Mailing Address - City:CASHION
Mailing Address - State:OK
Mailing Address - Zip Code:73016-9731
Mailing Address - Country:US
Mailing Address - Phone:405-433-5607
Mailing Address - Fax:877-463-3813
Practice Address - Street 1:7530 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4942
Practice Address - Country:US
Practice Address - Phone:405-787-4915
Practice Address - Fax:405-787-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200068070AMedicaid
OK200068070AMedicaid
OKH94966Medicare UPIN