Provider Demographics
NPI:1437189933
Name:WHITLOCK, BRYAN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:RICHARD
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-743-5438
Mailing Address - Fax:918-743-0664
Practice Address - Street 1:3319 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-743-5438
Practice Address - Fax:918-743-0664
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18447208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0BNDD15298OtherBUREAU OF NARCOTICS
OKBW3879876OtherDEA
OKBW3879876OtherDEA