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Individual

DR. BRYAN TREACY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1035 SW 19TH ST, SUITE B, MOORE, OK 73160-2883
(405) 793-9171
(405) 793-0815
Mailing address
PO BOX 6847, MOORE, OK 73153-0847
(405) 793-9171
(405) 793-0815

Taxonomy

Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
23781
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200036180A
OK
Enumeration date
10/12/2005
Last updated
03/30/2010
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