Provider Demographics
NPI:1982616538
Name:PRABHU, VIJAY N (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:N
Last Name:PRABHU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-752-3162
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:105 S BRYANT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6399
Practice Address - Country:US
Practice Address - Phone:405-340-4937
Practice Address - Fax:405-341-3078
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-05-20
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Provider Licenses
StateLicense IDTaxonomies
OK18818207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10097490AMedicaid
OKF84910Medicare UPIN
OK10097490AMedicaid