Provider Demographics
NPI:1013283209
Name:WILSON, MEGAN BREFFNEY (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BREFFNEY
Last Name:WILSON
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 1:112 WEST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5320
Mailing Address - Country:US
Mailing Address - Phone:918-752-1080
Mailing Address - Fax:918-752-1081
Practice Address - Street 1:112 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447
Practice Address - Country:US
Practice Address - Phone:918-752-1080
Practice Address - Fax:918-752-1081
Is Sole Proprietor?:No
Enumeration Date:2012-04-01
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine