Provider Demographics
NPI:1275776965
Name:BROWN, MARCUS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:MICHAEL
Last Name:BROWN
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 1:1001 S DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4424
Mailing Address - Country:US
Mailing Address - Phone:870-897-3456
Mailing Address - Fax:
Practice Address - Street 1:4500 S GARNETT RD
Practice Address - Street 2:300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5229
Practice Address - Country:US
Practice Address - Phone:870-897-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-11
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK315072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology