Provider Demographics
NPI:1043509474
Name:ELSE, BRITNEY (DO)
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:
Last Name:ELSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9645 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7423
Mailing Address - Country:US
Mailing Address - Phone:918-209-5170
Mailing Address - Fax:
Practice Address - Street 1:9645 RIVERSIDE PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7423
Practice Address - Country:US
Practice Address - Phone:918-209-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5502207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine