Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 1794 | OK |
Y | 207R00000X | Internist | 1794 | OK |
Y | 111NI0900X | Internist | 1794 | OK |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 1794 | OK |
N | 2081P2900X | Pain Medicine | 1794 | OK |
NPI | 1790747350 |
---|---|
Provider Name | Robert Joseph Breckenridge |
First Address | Enid, OK 73703-2524 |
Second Address | Enid, OK 73701-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100257360D | (05) | OK |
110230825 | RR MEDICARE (01) | |
37D2190466 | CLIA (01) | OK |
D97235 | (02) |