Individual
MR. JEFFREY ALLEN BRAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 WICKERSHAM ST, MANGUM, OK 73554-9117
(580) 782-3353
(580) 782-5103
Mailing address
1 WICKERSHAM ST, MANGUM, OK 73554-9117
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1849
OK
363AM0700X
Medical Physician Assistant
Primary
PA.0003313
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1849
LICENSE
OK
05
—
200264640A
—
OK
Enumeration date
05/07/2009
Last updated
11/26/2024
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