Provider Demographics
NPI:1104181973
Name:BAILEY, BRANDON MICHEAL (DO)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHEAL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 E 15TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5242
Mailing Address - Country:US
Mailing Address - Phone:918-935-3240
Mailing Address - Fax:918-935-3241
Practice Address - Street 1:2811 E 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5242
Practice Address - Country:US
Practice Address - Phone:918-935-3240
Practice Address - Fax:918-935-3241
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5349208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK409968YLYKMedicare PIN