Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LPO84 | OK |
N | 222Z00000X | Podiatrist | LPO84 | OK |
Y | 224P00000X | Prosthetist | LPO84 | OK |
NPI | 1255869533 |
---|---|
Provider Name | Brian Dayle Brame |
First Address | Tulsa, OK 74104-4614 |
Second Address | Tulsa, OK 74104-4614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2017 |
Last Update Date | 31/05/2017 |