Provider Demographics
NPI:1205826955
Name:HISEY, BRENT NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:NEAL
Last Name:HISEY
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 1:800 NW 9TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7253
Mailing Address - Country:US
Mailing Address - Phone:405-979-7875
Mailing Address - Fax:405-979-7880
Practice Address - Street 1:800 NW 9TH ST STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7253
Practice Address - Country:US
Practice Address - Phone:405-979-7875
Practice Address - Fax:405-979-7880
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK14408174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE08022Medicare UPIN