Organization
BETHANY MEDICAL CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS W. BRANT M.D. (OWNER)
(405) 789-2441
Entity
Organization
Contact information
Practice address
6801 NW 39TH EXPY, BETHANY, OK 73008-2501
(405) 789-2441
Mailing address
6801 NW 39TH EXPY, BETHANY, OK 73008-2501
(405) 789-2441
(405) 789-7978
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
9222
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH9820
MEDICARE RR GROUP
OK
Enumeration date
08/05/2007
Last updated
08/31/2020
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