1366444648 NPI number — DR. BRADFORD JAY STEPHENS M.D.

Table of content: DR. BRADFORD JAY STEPHENS M.D. (NPI 1366444648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366444648 NPI number — DR. BRADFORD JAY STEPHENS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENS
Provider First Name:
BRADFORD
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366444648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/31/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 A SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-541-9400
Provider Business Mailing Address Fax Number:
918-541-9411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 A SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-541-9400
Provider Business Practice Location Address Fax Number:
918-541-9411
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  18454 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100048810A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5975535 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 37D1002186 . This is a "CLIA WAIVE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: P00066051 . This is a "RAILROD MEDICARE PROVIDER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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