Provider Demographics
NPI:1497955082
Name:MATTHEW A MCBRIDE MD PC
Entity Type:Organization
Organization Name:MATTHEW A MCBRIDE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-949-4289
Mailing Address - Street 1:5701 N PORTLAND AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1678
Mailing Address - Country:US
Mailing Address - Phone:405-949-4289
Mailing Address - Fax:
Practice Address - Street 1:5701 N PORTLAND AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1678
Practice Address - Country:US
Practice Address - Phone:405-949-4289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19881207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF78142Medicare UPIN