Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 57565 | WI |
Y | 207YS0123X | Facial Plastic Surgeon | 5413 | OK |
N | 207YS0123X | Facial Plastic Surgeon | OS014959 | PA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 57565 | WI |
NPI | 1134336373 |
---|---|
Provider Name | Dr. Bradley Russell Mons |
First Address | Tulsa, OK 74104-5647 |
Second Address | Tulsa, OK 74104-5647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 05/10/2018 |