Healthcare Provider Details

I. General information

NPI: 1093370603
Provider Name (Legal Business Name): MARK STEPHENS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LINCOLN BLVD
OKLAHOMA CITY OK
73104-3252
US

IV. Provider business mailing address

10508 WHITEHAVEN RD
OKLAHOMA CITY OK
73120-3038
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7000
  • Fax:
Mailing address:
  • Phone: 210-854-5622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number34874
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: