Provider Demographics
NPI:1497562441
Name:TRENTHAM, BRANDON JAY
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAY
Last Name:TRENTHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W 119TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3357
Mailing Address - Country:US
Mailing Address - Phone:918-521-7088
Mailing Address - Fax:
Practice Address - Street 1:5350 S PEORIA AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6820
Practice Address - Country:US
Practice Address - Phone:918-749-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker