Provider Demographics
NPI:1528253366
Name:JAMES R BRIXEY DO PC
Entity type:Organization
Organization Name:JAMES R BRIXEY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRIXEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-456-2549
Mailing Address - Street 1:1500 E DOWNING ST
Mailing Address - Street 2:STE 101
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 E DOWNING ST
Practice Address - Street 2:STE 101
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3354
Practice Address - Country:US
Practice Address - Phone:918-456-2549
Practice Address - Fax:918-456-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5180Medicare PIN
D38514Medicare UPIN