Provider Demographics
NPI:1114638590
Name:MCCHAREN, BRYAN SCOTT
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:SCOTT
Last Name:MCCHAREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11158 LARKIN LN
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3824
Mailing Address - Country:US
Mailing Address - Phone:808-351-6716
Mailing Address - Fax:
Practice Address - Street 1:11158 LARKIN LN
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3824
Practice Address - Country:US
Practice Address - Phone:808-351-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator