Provider Demographics
NPI:1508835190
Name:WINGO, JAMES BRENDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRENDAN
Last Name:WINGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1501 N FLORENCE
Mailing Address - Street 2:STE 201
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3189
Mailing Address - Country:US
Mailing Address - Phone:918-341-1886
Mailing Address - Fax:918-343-1727
Practice Address - Street 1:1501 N FLORENCE
Practice Address - Street 2:STE 201
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3189
Practice Address - Country:US
Practice Address - Phone:918-341-1886
Practice Address - Fax:918-343-1727
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK18080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100070070AMedicaid
OKOKAAA2128Medicare PIN
OKG04100Medicare UPIN