Individual
MR. BREECE MICHAEL EBERLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10502 N 110TH EAST AVE, OWASSO, OK 74055-6655
(918) 376-8190
(918) 376-8479
Mailing address
603 NORTH PROGRESS AVE, SILOAM SPRINGS, AR 72761-4353
(479) 215-3050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21230
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100259460A
—
OK
Enumeration date
05/17/2006
Last updated
07/23/2015
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