Active NPI
Bruce Kimball Brookby, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Tulsa, OK
National Provider Identifier
1851312516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 9947
- Practice address
- 1923 S Utica Ave
Tulsa, OK 74104-6520 - Phone
- (918) 744-2553
- Fax
- (918) 744-3482
- NPI assigned
- Jul 21, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 9947 | OK | Primary |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 04-17787 | KS | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 34571 | MO |
Addresses
Primary practice location
1923 S Utica Ave
Tulsa, OK 74104-6520
Mailing address
1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-2553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-17787 | KS | MD | Anatomic Pathology & Clinical Pathology Physician |
| 34571 | MO | MD | Anatomic Pathology & Clinical Pathology Physician |
| 9947 | OK | MD | Anatomic Pathology & Clinical Pathology Physician |
Interoperability endpoints
- john.cai@direct.stjohnhealthsystem.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1851312516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1923 S UTICA AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741046520",
"telephone_number": "918-744-2553",
"fax_number": "918-744-3482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1923 S UTICA AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741046520",
"telephone_number": "918-744-2553",
"fax_number": "918-744-3482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKBY",
"first_name": "BRUCE",
"middle_name": "KIMBALL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "OK",
"license": "9947",
"primary": true
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "KS",
"license": "04-17787",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MO",
"license": "34571",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Tulsa, OK
- Broken Arrow Medical LLC
- Broken Arrow Orthopedics Inc
- Alan Lee Brokenicky, PA
- Bailee Bronson
- Sierra Brood
- Brookdale Senior Living Communities, Inc. (Sterling House of Tulsa South)
- Brookdale Senior Living Communities, Inc. (Sterling House of Tulsa)
- Heather Dawn Brooke, BHRS
- Brookhaven Hospital
- Brookhaven Hospital Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.