Provider Demographics
NPI:1679644348
Name:MARION, BRAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:A
Last Name:MARION
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6205 N SANTA FE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7537
Mailing Address - Country:US
Mailing Address - Phone:405-272-8338
Mailing Address - Fax:405-272-6030
Practice Address - Street 1:6205 N SANTA FE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7537
Practice Address - Country:US
Practice Address - Phone:405-272-8338
Practice Address - Fax:405-272-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2020-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK12510207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100057450AMedicaid
OK100057450AMedicaid