Provider Demographics
NPI:1992021802
Name:BRAR, PAVAN (MD)
Entity Type:Individual
Prefix:
First Name:PAVAN
Middle Name:
Last Name:BRAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-3893
Mailing Address - Country:US
Mailing Address - Phone:918-650-1100
Mailing Address - Fax:918-650-0568
Practice Address - Street 1:2403 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-3893
Practice Address - Country:US
Practice Address - Phone:918-650-1100
Practice Address - Fax:918-650-0568
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27791208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist