Provider Demographics
NPI:1376177253
Name:VINSON, BRYAN LAMONT JR
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:LAMONT
Last Name:VINSON
Suffix:JR
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 1:8133 EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6077
Mailing Address - Country:US
Mailing Address - Phone:405-210-9502
Mailing Address - Fax:
Practice Address - Street 1:8133 EAGLE CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-6077
Practice Address - Country:US
Practice Address - Phone:405-210-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator