Organization
BJT MD PLLC
Active
Other names
Bryan J Treacy, MD LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN J TREACY MD (OWNER/PHYSICIAN)
(405) 793-9171
Entity
Organization
Contact information
Practice address
1035 SW 19TH ST, SUITE B, MOORE, OK 73160-2883
(405) 793-9171
(405) 793-0815
Mailing address
PO BOX 6847, MOORE, OK 73153-0847
(405) 793-9171
(405) 793-0815
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
23781
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200263670A
—
OK
Enumeration date
07/25/2008
Last updated
04/24/2012
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