Provider Demographics
NPI:1174577415
Name:HOYT, BRADLEY DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DEAN
Last Name:HOYT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4214
Mailing Address - Country:US
Mailing Address - Phone:918-382-2536
Mailing Address - Fax:918-382-2576
Practice Address - Street 1:1245 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4214
Practice Address - Country:US
Practice Address - Phone:918-382-2536
Practice Address - Fax:918-382-2576
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112420AMedicaid
249425108Medicare ID - Type Unspecified
OK100112420AMedicaid