Basic Information
| Provider Information | |||||||||
| NPI: | 1790343085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRANT BENNETT, MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 SUMMIT CREST LN | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730714083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059240050 | ||||||||
| FaxNumber: | 4052934365 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 HEALTHPLEX PKWY # 102 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730729738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053076955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2019 | ||||||||
| LastUpdateDate: | 05/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | BRANT | ||||||||
| AuthorizedOfficialMiddleName: | QUINN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4059240050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.