Provider Demographics
NPI:1629365085
Name:E BRADLEY GARBER, M.D., P.C.
Entity Type:Organization
Organization Name:E BRADLEY GARBER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-745-2117
Mailing Address - Street 1:1784 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5336
Mailing Address - Country:US
Mailing Address - Phone:918-745-2117
Mailing Address - Fax:918-745-2178
Practice Address - Street 1:1784 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5336
Practice Address - Country:US
Practice Address - Phone:918-745-2117
Practice Address - Fax:918-745-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK150592086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100084420AMedicaid
OK100084420AMedicaid