Healthcare Provider Details

I. General information

NPI: 1609811801
Provider Name (Legal Business Name): ROBIN LINDELL STEVENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 US HWY 412
COLCORD OK
74338-4168
US

IV. Provider business mailing address

100 REMINGTON PL
TAHLEQUAH OK
74464-4168
US

V. Phone/Fax

Practice location:
  • Phone: 918-422-5750
  • Fax: 918-422-4351
Mailing address:
  • Phone: 918-457-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number12183
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: