Provider Demographics
NPI:1477792562
Name:HERB, BRIAN HORST (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HORST
Last Name:HERB
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7919 MID AMERICA BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6610
Mailing Address - Country:US
Mailing Address - Phone:405-855-6000
Mailing Address - Fax:
Practice Address - Street 1:7919 MID AMERICA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-6610
Practice Address - Country:US
Practice Address - Phone:405-855-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1086048363A00000X
OK2253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant