Individual
DR. BRENT WADE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
315 W. 9 STREET, WELEETKA, OK 74880-0337
(405) 786-2248
(405) 786-2006
Mailing address
PO BOX 207, HENRYETTA, OK 74437-0207
(405) 786-2248
(405) 786-2006
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1913
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100743630A
—
OK
05
—
100743630B
—
OK
Enumeration date
03/12/2007
Last updated
07/08/2011
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