Provider Demographics
NPI:1093854093
Name:RANEY, BRANNON (MD)
Entity Type:Individual
Prefix:
First Name:BRANNON
Middle Name:
Last Name:RANEY
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 1:6565 S YALE AVE
Mailing Address - Street 2:SUITE 812
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8354
Mailing Address - Country:US
Mailing Address - Phone:918-494-9486
Mailing Address - Fax:918-494-9480
Practice Address - Street 1:6565 S YALE AVE
Practice Address - Street 2:SUITE 812
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8354
Practice Address - Country:US
Practice Address - Phone:918-494-9486
Practice Address - Fax:918-494-9480
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9597207RI0200X
OK29436207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BQ792OtherBCBS
OKOKA105609Medicare PIN
TX8BQ792OtherBCBS