1316006562 NPI number — BRADFORD JAY STEPHENS MD PC

Table of content: (NPI 1316006562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316006562 NPI number — BRADFORD JAY STEPHENS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRADFORD JAY STEPHENS MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316006562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

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:
74354-7604
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:
74354-6708
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:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHENS
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-541-9400

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: 136644648 . This is a "NPI NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: DH0106 . This is a "MEDICARE RAIL ROAD" identifier . This identifiers is of the category "OTHER".
  • 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: G43709 . This is a "UPIN" 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".




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