Basic Information
| Provider Information | |||||||||
| NPI: | 1679644348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARION | ||||||||
| FirstName: | BRAD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6205 N SANTA FE AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731187537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052728338 | ||||||||
| FaxNumber: | 4052726030 | ||||||||
| Practice Location | |||||||||
| Address1: | 6205 N SANTA FE AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731187537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052728338 | ||||||||
| FaxNumber: | 4052726030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 12510 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 100057450A | 05 | OK | MEDICAID |