Provider Demographics
NPI:1316431554
Name:VINCENT, BRADY L (DO)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:L
Last Name:VINCENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 E 81ST ST STE 3700
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4257
Mailing Address - Country:US
Mailing Address - Phone:918-695-0669
Mailing Address - Fax:
Practice Address - Street 1:2448 E 81ST ST STE 3700
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4257
Practice Address - Country:US
Practice Address - Phone:918-695-0669
Practice Address - Fax:918-561-8428
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK67932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program