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Individual

BROOKE A NIDA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1700 S RENAISSANCE BLVD, EDMOND, OK 73013
(405) 844-4300
(405) 844-4333
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(405) 844-4300
(405) 844-4333

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
24592
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200194500A
OK
05
200194500B
OK
Enumeration date
02/12/2007
Last updated
07/14/2017
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