Provider Demographics
NPI:1700880127
Name:STUTZMAN, BRENDA R (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:R
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:579 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048-8425
Mailing Address - Country:US
Mailing Address - Phone:405-663-2291
Mailing Address - Fax:405-663-2191
Practice Address - Street 1:579 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HYDRO
Practice Address - State:OK
Practice Address - Zip Code:73048-8425
Practice Address - Country:US
Practice Address - Phone:405-663-2291
Practice Address - Fax:405-663-2191
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine