Individual
ROYAL BRADLEY WHINERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1710 W 3RD ST, SUITE 103, ELK CITY, OK 73644-5159
(580) 225-1290
(580) 225-2178
Mailing address
1710 W 3RD ST, SUITE 103, ELK CITY, OK 73644-5159
(580) 225-1290
(580) 225-2178
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26230
OK
207Q00000X
Family Medicine Physician
6420
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200202430A
—
OK
Enumeration date
05/03/2007
Last updated
12/21/2010
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