Provider Demographics
NPI:1518929645
Name:SAXON, BRUCE C (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
Last Name:SAXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8131 S MEMORIAL DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4347
Mailing Address - Country:US
Mailing Address - Phone:918-252-5114
Mailing Address - Fax:334-395-4110
Practice Address - Street 1:DEPT 1654
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74182-0001
Practice Address - Country:US
Practice Address - Phone:334-279-1450
Practice Address - Fax:334-395-4110
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK15325207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100131310AMedicaid
OKP00377485OtherRR MEDICARE
OK100131310AMedicaid
OK249601311Medicare PIN