Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 24887 | OK |
N | 207QS0010X | Family Doctor - Sports Medicine | 24887 | OK |
NPI | 1063436947 |
---|---|
Provider Name | Brian Keith Rich |
First Address | Irving, TX 75038-6419 |
Second Address | Mcalester, OK 74501-4285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 19/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200093580A | (05) | OK |