Basic Information
| Provider Information | |||||||||
| NPI: | 1871536920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCBRIDE | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3366 NW EXPRESSWAY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057021300 | ||||||||
| FaxNumber: | 4057021280 | ||||||||
| Practice Location | |||||||||
| Address1: | 5015 N PENNSYLVANIA AVE | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731128891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057676630 | ||||||||
| FaxNumber: | 4057671176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 12/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 19881 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 100042450A | 05 | OK | MEDICAID |