Provider Demographics
NPI:1811008576
Name:WILLIAM C BRASHER
Entity Type:Organization
Organization Name:WILLIAM C BRASHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:405-382-4050
Mailing Address - Street 1:PO BOX 3699
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-3699
Mailing Address - Country:US
Mailing Address - Phone:405-382-4050
Mailing Address - Fax:405-382-1462
Practice Address - Street 1:100 SE 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-3616
Practice Address - Country:US
Practice Address - Phone:405-382-4050
Practice Address - Fax:405-382-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0024840367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200007140AMedicaid
OK200522017Medicare PIN