Provider Demographics
NPI:1225037427
Name:BRUTON, BOBBIE LEE (MD)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:LEE
Last Name:BRUTON
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 1:3910 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3606
Mailing Address - Country:US
Mailing Address - Phone:918-497-3500
Mailing Address - Fax:918-497-3531
Practice Address - Street 1:3910 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3606
Practice Address - Country:US
Practice Address - Phone:918-497-3500
Practice Address - Fax:918-497-3531
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94725Medicare UPIN