| Brian A. Boatwright, Psy.d., P.l.l.c. | |
|
5272 S Lewis Ave Ste 250 Tulsa OK 74105-6564 | |
| (918) 524-3300 | |
| (918) 524-3302 |
| Full Name | Brian A. Boatwright, Psy.d., P.l.l.c. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 5272 S Lewis Ave Ste 250, Tulsa, Oklahoma |
| Authorized Official Name and Position | Brian A. Boatwright (NEUROPSYCHOLOGIST) |
| Authorized Official Contact | 6154155767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian A. Boatwright, Psy.d., P.l.l.c. 2935 E 75th St Tulsa OK 74136-5642 Ph: (615) 415-5767 | Brian A. Boatwright, Psy.d., P.l.l.c. 5272 S Lewis Ave Ste 250 Tulsa OK 74105-6564 Ph: (918) 524-3300 |
| NPI Number | 1295091411 |
|---|---|
| Provider Enumeration Date | 04/02/2012 |
| Last Update Date | 04/02/2012 |
| Medicare PECOS PAC ID | 8921263591 |
|---|---|
| Medicare Enrollment ID | O20120705000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295091411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 1144 (Oklahoma) | Primary |
| Provider Name | Brian A. Boatwright |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366722712 PECOS PAC ID: 9830354406 Enrollment ID: I20120705000103 |
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