Provider Demographics
NPI:1932572120
Name:BROU ENTERPRISES LLC
Entity Type:Organization
Organization Name:BROU ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZIGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-945-0001
Mailing Address - Street 1:13128 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-3017
Mailing Address - Country:US
Mailing Address - Phone:405-945-0001
Mailing Address - Fax:405-945-0004
Practice Address - Street 1:13128 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-3017
Practice Address - Country:US
Practice Address - Phone:405-945-0001
Practice Address - Fax:405-945-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK310562086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty