Provider Demographics
NPI:1790984938
Name:MARK P BRITT, MD PLLC
Entity Type:Organization
Organization Name:MARK P BRITT, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-376-8578
Mailing Address - Street 1:DEPT 2108
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:918-622-8513
Mailing Address - Fax:918-622-8552
Practice Address - Street 1:10502 N 110TH EAST AVE
Practice Address - Street 2:STE 334
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6655
Practice Address - Country:US
Practice Address - Phone:918-376-8578
Practice Address - Fax:918-376-8579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16604207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522142Medicare PIN
OKF21072Medicare UPIN