Provider Demographics
NPI:1033186473
Name:LEVY, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 N BRYANT AVE
Mailing Address - Street 2:C4
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6305
Mailing Address - Country:US
Mailing Address - Phone:405-330-7606
Mailing Address - Fax:405-330-7607
Practice Address - Street 1:124 N BRYANT AVE
Practice Address - Street 2:C4
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6305
Practice Address - Country:US
Practice Address - Phone:405-330-7606
Practice Address - Fax:405-330-7607
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100257590BMedicaid
OK446800272Medicare ID - Type Unspecified
OK100257590BMedicaid