Provider Demographics
NPI:1306817887
Name:BROOME, JOSEPH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:BROOME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4942
Mailing Address - Country:US
Mailing Address - Phone:405-787-4915
Mailing Address - Fax:405-789-6303
Practice Address - Street 1:7530 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4921
Practice Address - Country:US
Practice Address - Phone:405-787-4915
Practice Address - Fax:405-789-6303
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK23006OtherSTATE MEDICAL LICENSE
OKRAILROAD MEDICAREOtherP00325461
OKH94966Medicare UPIN
OK200059010AMedicaid
OK245534601Medicare PIN