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General NPI Number Information
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NPI Number | 1205804424
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Entity Type | Individual
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Provider Name | GEORGE KELLOGG STEPHENS III MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 2017 W I 35 FRONTAGE RD
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City | EDMOND
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State | OK
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Zip | 73013-8504
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Country | US
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Telephone | 405-757-3365
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Fax | 405-757-3498
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Provider Business Mailing Address
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Address Line | 4345 W MEMORIAL RD STE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-1702
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Country | US
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Telephone | 405-936-5800
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Fax | 405-936-5211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 15338
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License Number State | OK
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