Provider Demographics
NPI:1780155945
Name:BRANHAM, BRENT
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:BRANHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 LINWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-2628
Mailing Address - Country:US
Mailing Address - Phone:405-232-1864
Mailing Address - Fax:405-799-7528
Practice Address - Street 1:11601 W STANLEY DRAPER DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-6503
Practice Address - Country:US
Practice Address - Phone:405-802-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist