Provider Demographics
NPI:1801988597
Name:NORRIS, BRENT LANE (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LANE
Last Name:NORRIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2424 E 21ST ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1722
Mailing Address - Country:US
Mailing Address - Phone:918-392-4547
Mailing Address - Fax:918-392-4555
Practice Address - Street 1:2424 E 21ST ST
Practice Address - Street 2:SUITE 320
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1722
Practice Address - Country:US
Practice Address - Phone:918-392-4547
Practice Address - Fax:918-392-4555
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-03-22
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Provider Licenses
StateLicense IDTaxonomies
OK25287207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200096320AMedicaid
OKP00684517OtherRAILROAD MEDICARE
OKG35118Medicare UPIN