Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD0000046600 | TN |
N | 111NI0900X | Internist | MD0000046600 | TN |
N | 207R00000X | Internist | TP927 | KY |
N | 111NI0900X | Internist | TP927 | KY |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 32126 | OK |
NPI | 1023282423 |
---|---|
Provider Name | Dr. Jordan A Brewster |
First Address | Tulsa, OK 74133-5718 |
Second Address | Tulsa, OK 74104-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 16/06/2016 |