Individual
ALAN LEE BROKENICKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
9912 E 21ST ST, TULSA, OK 74129-1620
(918) 622-0641
Mailing address
1705 E 19TH ST, STE 302, TULSA, OK 74104-5410
(918) 748-7585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1752
OK
Other
Enumeration date
07/23/2008
Last updated
01/12/2017
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