Provider Demographics
NPI:1982925913
Name:BRYAN, BRIDGET DIANE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:DIANE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BRIDGET
Other - Middle Name:DIANE
Other - Last Name:FLAUDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2100 W IOWA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2736
Mailing Address - Country:US
Mailing Address - Phone:405-224-2100
Mailing Address - Fax:405-779-2365
Practice Address - Street 1:2100 W IOWA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2736
Practice Address - Country:US
Practice Address - Phone:405-224-2100
Practice Address - Fax:405-779-2365
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5036208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200397150AMedicaid
OK200397150AMedicaid
OK286704ZN2YMedicare PIN