Healthcare Provider Details

I. General information

NPI: 1457462574
Provider Name (Legal Business Name): JOHN E STECKLOW M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 NW 56TH ST SUITE 320
OKLAHOMA CITY OK
73112-4526
US

IV. Provider business mailing address

3613 NW 56TH ST SUITE 320
OKLAHOMA CITY OK
73112-4526
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-5505
  • Fax: 405-949-0718
Mailing address:
  • Phone: 405-949-5505
  • Fax: 405-949-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number20247
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: