Provider Demographics
NPI:1043506751
Name:STORER, BROOKE L (MD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:L
Last Name:STORER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13921 N. MERIDIAN AVE.
Mailing Address - Street 2:STE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1104
Mailing Address - Country:US
Mailing Address - Phone:405-755-7430
Mailing Address - Fax:405-755-6319
Practice Address - Street 1:13921 N. MERIDIAN AVE.
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1104
Practice Address - Country:US
Practice Address - Phone:405-755-7430
Practice Address - Fax:405-755-6319
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28529207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200446190AMedicaid