Provider Demographics
NPI:1700847118
Name:BRIGGEMAN, ANDREW R (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:BRIGGEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21052
Mailing Address - Street 2:DEPT. 22415
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1052
Mailing Address - Country:US
Mailing Address - Phone:918-994-4810
Mailing Address - Fax:918-994-4816
Practice Address - Street 1:6825 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-4502
Practice Address - Country:US
Practice Address - Phone:918-994-4810
Practice Address - Fax:918-994-4816
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK4055208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200014830AMedicaid
OKA101051Medicare PIN