Provider Demographics
NPI:1447298120
Name:VANDOREN, BRYAN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ANDREW
Last Name:VANDOREN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9320 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5710
Mailing Address - Country:US
Mailing Address - Phone:918-901-9701
Mailing Address - Fax:918-710-4118
Practice Address - Street 1:9320 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5710
Practice Address - Country:US
Practice Address - Phone:918-901-9701
Practice Address - Fax:918-901-9702
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK173132083A0300X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100229400AMedicaid