Provider Demographics
NPI:1427164888
Name:CODER, BRIAN (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:CODER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ARTHUR
Other - Middle Name:BRIAN
Other - Last Name:CODER
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:705 W OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1656
Mailing Address - Country:US
Mailing Address - Phone:918-251-2666
Mailing Address - Fax:918-893-4036
Practice Address - Street 1:705 W OAKLAND ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1656
Practice Address - Country:US
Practice Address - Phone:918-251-2666
Practice Address - Fax:918-893-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100090910AMedicaid
OK100090910BMedicaid
OKG06563Medicare UPIN
OK100090910BMedicaid