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Individual

DR. ERIC S. BROADWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1505 E MAIN ST, STIGLER, OK 74462-2913
(918) 967-3368
(918) 967-4582
Mailing address
PO BOX 179, STIGLER, OK 74462-0179
(918) 967-4560
(918) 967-4582

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
16956
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100119810A
OK
01
16956
MEDICAL LICENSE
OK
Enumeration date
10/04/2006
Last updated
11/17/2009
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