Individual
BRENT ALAN WAKEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 E MAIN ST, JENKS, OK 74037-4138
(918) 299-8080
(918) 298-2838
Mailing address
615 E MAIN ST, JENKS, OK 74037-4138
(918) 299-8080
(918) 298-2838
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22988
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
441911615001
BLUECROSS BLUESHIELD
OK
01
—
7837678
AETNA
OK
Enumeration date
10/25/2006
Last updated
03/24/2008
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