Healthcare Provider Details

I. General information

NPI: 1225293012
Provider Name (Legal Business Name): SAVANNAH DELK STUMPH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAVANNAH DELK BAKER

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 W 15TH ST BUILDING 200
EDMOND OK
73013-3666
US

IV. Provider business mailing address

416 W 15TH ST BUILDING 200
EDMOND OK
73013-3747
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-5800
  • Fax: 405-471-5861
Mailing address:
  • Phone: 405-471-5800
  • Fax: 405-471-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number390200000X
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: