Healthcare Provider Details

I. General information

NPI: 1013937911
Provider Name (Legal Business Name): BRUCE CARLTON STOESSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 E 48TH ST S
TULSA OK
74146-5830
US

IV. Provider business mailing address

10901 E 48TH ST S
TULSA OK
74146-5830
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-8765
  • Fax: 918-392-2155
Mailing address:
  • Phone: 918-749-8765
  • Fax: 918-392-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number10459
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: