Provider Demographics
NPI:1942513312
Name:BRAGG, JEFFREY SR (LHIS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BRAGG
Suffix:SR
Gender:M
Credentials:LHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W HEFNER RD
Mailing Address - Street 2:STE K
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7621
Mailing Address - Country:US
Mailing Address - Phone:405-751-2552
Mailing Address - Fax:405-751-2552
Practice Address - Street 1:2222 W HEFNER RD
Practice Address - Street 2:STE K
Practice Address - City:THE VILLAGE
Practice Address - State:OK
Practice Address - Zip Code:73120-7621
Practice Address - Country:US
Practice Address - Phone:405-751-2552
Practice Address - Fax:405-751-2552
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK385237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist