Healthcare Provider Details

I. General information

NPI: 1013987288
Provider Name (Legal Business Name): STEVEN L. NUSSBAUM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9716 RIVERSIDE PARKWAY SUITE 100
TULSA OK
74137
US

IV. Provider business mailing address

9716 RIVERSIDE PKWY SUITE 100
TULSA OK
74137-7447
US

V. Phone/Fax

Practice location:
  • Phone: 918-299-4333
  • Fax: 918-299-4330
Mailing address:
  • Phone: 918-299-4333
  • Fax: 918-299-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.004602
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number3826
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3826
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3826
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: