Healthcare Provider Details

I. General information

NPI: 1679549166
Provider Name (Legal Business Name): RONALD ALLAN STILLERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 E 41ST ST STE 900
TULSA OK
74135-5631
US

IV. Provider business mailing address

PO BOX 4930
TULSA OK
74159-0930
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-4975
  • Fax: 918-743-8552
Mailing address:
  • Phone: 918-747-4975
  • Fax: 918-743-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberOS8335
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOP61629350
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3604
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: