Provider Demographics
NPI:1982899233
Name:PRATT, BRIAN D (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:PRATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 HARLI LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7294
Mailing Address - Country:US
Mailing Address - Phone:405-735-5316
Mailing Address - Fax:
Practice Address - Street 1:14301 HARLI LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7294
Practice Address - Country:US
Practice Address - Phone:405-735-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4549207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120050AMedicaid
OKOK402575Medicare PIN