Provider Demographics
NPI:1407824501
Name:LAUGHLIN, BRENT W (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:W
Last Name:LAUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5633
Mailing Address - Country:US
Mailing Address - Phone:918-748-7640
Mailing Address - Fax:918-403-6317
Practice Address - Street 1:1919 S WHEELING AVE STE 404
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-7640
Practice Address - Fax:918-403-6317
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100074410AMedicaid
OK100074410AMedicaid