Provider Demographics
NPI:1912231713
Name:BRANNON, TODD (HIS)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:BRANNON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W MEMORIAL RD
Mailing Address - Street 2:SUITE 259A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-8039
Mailing Address - Country:US
Mailing Address - Phone:405-755-6557
Mailing Address - Fax:
Practice Address - Street 1:2501 W MEMORIAL RD
Practice Address - Street 2:SUITE 259A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-8039
Practice Address - Country:US
Practice Address - Phone:405-755-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK841237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist