Provider Demographics
NPI:1174244313
Name:MIDTOWN OBGYN
Entity type:Organization
Organization Name:MIDTOWN OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OBGYN
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:MARAY
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-549-0497
Mailing Address - Street 1:667 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-2645
Mailing Address - Country:US
Mailing Address - Phone:918-549-0497
Mailing Address - Fax:
Practice Address - Street 1:1705 E 19TH ST STE 701
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5418
Practice Address - Country:US
Practice Address - Phone:918-549-0497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty