Provider Demographics
NPI:1861958159
Name:BRENT W LAUGHLIN MD PLLC
Entity type:Organization
Organization Name:BRENT W LAUGHLIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-645-7984
Mailing Address - Street 1:2000 S WHEELING AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5644
Mailing Address - Country:US
Mailing Address - Phone:918-986-7979
Mailing Address - Fax:918-986-7945
Practice Address - Street 1:2000 S WHEELING AVE STE 700
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5644
Practice Address - Country:US
Practice Address - Phone:918-986-7979
Practice Address - Fax:918-986-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty