Individual
DR. BRIAN GILLAM BIRDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4202 SW LEE BLVD, LAWTON, OK 73505-8300
(580) 248-9966
(580) 248-8313
Mailing address
4202 SW LEE BLVD, LAWTON, OK 73505-8300
(580) 248-9966
(580) 248-8313
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13900
OK
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
13900
OK
2083X0100X
Occupational Medicine Physician
13900
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100824240
—
OK
Enumeration date
08/18/2005
Last updated
12/22/2011
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