Individual
BRIAN ANDREW JANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5050 SW LEE BLVD, SUITE 2, LAWTON, OK 73505
(580) 699-8822
(580) 699-8824
Mailing address
7800 NW 85TH TER, OKLAHOMA CITY, OK 73132-3385
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2393
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200542940A
—
OK
01
—
P01409653
RR MEDICARE
OK
Enumeration date
06/09/2011
Last updated
10/26/2022
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