Provider Demographics
NPI:1679508568
Name:SPILLARS, RODGER BRANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:RODGER
Middle Name:BRANNON
Last Name:SPILLARS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 295
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-294-9865
Mailing Address - Fax:918-294-9866
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:STE 295
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-294-9865
Practice Address - Fax:918-294-9866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100132160CMedicaid
OK100132160AMedicaid
OK100132160CMedicaid