Provider Demographics
NPI:1962660688
Name:BRANAM, MISTY QUINN (DO)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:QUINN
Last Name:BRANAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 E CLARK BASS BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4209
Mailing Address - Country:US
Mailing Address - Phone:918-421-8966
Mailing Address - Fax:918-421-8990
Practice Address - Street 1:4 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4269
Practice Address - Country:US
Practice Address - Phone:918-421-8966
Practice Address - Fax:918-421-8990
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine