Provider Demographics
NPI:1972852242
Name:BROTHERS, EMANUEL A (BS BHRS)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:A
Last Name:BROTHERS
Suffix:
Gender:M
Credentials:BS BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 NE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4607
Mailing Address - Country:US
Mailing Address - Phone:405-824-3125
Mailing Address - Fax:
Practice Address - Street 1:819 NE 16TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4607
Practice Address - Country:US
Practice Address - Phone:405-824-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1659685402Medicaid