Provider Demographics
NPI:1619465457
Name:PFENNINGER, BRIAN (MBA, RDCS, RDMS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PFENNINGER
Suffix:
Gender:M
Credentials:MBA, RDCS, RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 NW 159TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3220
Mailing Address - Country:US
Mailing Address - Phone:405-330-2225
Mailing Address - Fax:405-832-1172
Practice Address - Street 1:2805 S BRYANT AVE STE B
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6158
Practice Address - Country:US
Practice Address - Phone:405-330-2225
Practice Address - Fax:405-832-1172
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1465282085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound