Healthcare Provider Details

I. General information

NPI: 1134171648
Provider Name (Legal Business Name): STEPHEN COLE GAUTHIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6516 N OLIE AVE SUITE E
OKLAHOMA CITY OK
73116-7226
US

IV. Provider business mailing address

6516 N OLIE AVE SUITE E
OKLAHOMA CITY OK
73116-7226
US

V. Phone/Fax

Practice location:
  • Phone: 405-286-5606
  • Fax: 405-286-5607
Mailing address:
  • Phone: 405-286-5606
  • Fax: 405-286-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number21236
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: