Individual provider · NPI-1

Elise I Brantley, MD

Dermatology · Oklahoma City, OK

NPI number1215148507
StatusActive
Last updated in NPPESJun 3, 2021

Details

NPI
1215148507
Entity type
Individual (NPI-1)
Name
Elise I Brantley
Credential
MD
Sex
Female
Sole proprietor
No
Enumeration date
May 25, 2007
Certification date
Jun 3, 2021
Last updated
Jun 3, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207N00000X Dermatology28488OKYes

Practice location

3030 Nw 149th St
Oklahoma City, OK 73134-1849

Phone 405-562-6222 · Fax 405-562-6522

Mailing address

3030 Nw 149th St
Oklahoma City, OK 73134-1849

Phone 405-562-6222 · Fax 405-562-6522

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