Individual
BRAULIO MANNY CUESTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 BRYAN DR, DURANT, OK 74701-2158
(580) 920-0105
(580) 920-0893
Mailing address
1400 BRYAN DR, DURANT, OK 74701-2158
(580) 920-0105
(580) 920-0893
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
13348
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100129250A
—
OK
Enumeration date
05/30/2006
Last updated
04/01/2011
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