Healthcare Provider Details

I. General information

NPI: 1033146832
Provider Name (Legal Business Name): STEPHEN L CARPENTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 S MACARTHUR BLVD CAMI BUILDING ROOM B-13
OKLAHOMA CITY OK
73169-6907
US

IV. Provider business mailing address

13205 SPRINGCREEK CT
OKLAHOMA CITY OK
73170-1448
US

V. Phone/Fax

Practice location:
  • Phone: 405-954-3341
  • Fax: 405-954-3345
Mailing address:
  • Phone: 405-703-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number11779
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: