Provider Demographics
NPI:1487614699
Name:BROU, JUAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:BROU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 N GRAND BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5647
Mailing Address - Country:US
Mailing Address - Phone:405-945-0001
Mailing Address - Fax:405-945-0004
Practice Address - Street 1:5300 N GRAND BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5647
Practice Address - Country:US
Practice Address - Phone:405-945-0001
Practice Address - Fax:405-945-0004
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK17485208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE90217Medicare UPIN