Individual
MARK A. BRANDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2929 S GARNETT RD, TULSA, OK 74129-5101
(918) 665-1520
(405) 749-4561
Mailing address
PO BOX 22063, DEPT 0289, TULSA, OK 74121-2063
(405) 751-4664
(405) 749-4561
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
18449
OK
207P00000X
Emergency Medicine Physician
2022000630
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100249150B
—
OK
Enumeration date
05/01/2006
Last updated
03/08/2022
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