Healthcare Provider Details

I. General information

NPI: 1023496940
Provider Name (Legal Business Name): STEPHEN THOMAS MAHONEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY STE 800
OKLAHOMA CITY OK
73112-4458
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-9935
  • Fax: 405-713-9936
Mailing address:
  • Phone: 405-713-9935
  • Fax: 405-713-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39325
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number39325
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: