Healthcare Provider Details

I. General information

NPI: 1457092629
Provider Name (Legal Business Name): STEVEN K IPSEN JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OSU MEDICAL CENTER 744 WEST 9TH STREET TULSA, OK 74127-
TULSA OK
74127
US

IV. Provider business mailing address

10092 S MAJESTIC CANYON RD
SANDY UT
84092-4524
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-1000
  • Fax:
Mailing address:
  • Phone: 801-541-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: