Healthcare Provider Details

I. General information

NPI: 1417287871
Provider Name (Legal Business Name): MICHAEL JAMES STANCLIFF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 N ROCKWELL AVE
OKLAHOMA CITY OK
73162-2725
US

IV. Provider business mailing address

11220 N ROCKWELL AVE
OKLAHOMA CITY OK
73162-2725
US

V. Phone/Fax

Practice location:
  • Phone: 405-722-9474
  • Fax: 405-722-9463
Mailing address:
  • Phone: 405-722-9474
  • Fax: 405-722-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1868
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: