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General NPI Number Information
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NPI Number | 1316006562
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Entity Type | Organization
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Legal Business Name | BRADFORD JAY STEPHENS MD PC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 202 A SW
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City | MIAMI
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State | OK
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Zip | 74354-6708
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Country | US
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Telephone | 918-541-9400
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Fax | 918-541-9411
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Provider Business Mailing Address
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Address Line | 202 A SW
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City | MIAMI
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State | OK
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Zip | 74354-7604
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Country | US
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Telephone | 918-541-9400
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Fax | 918-541-9411
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Authorized Official
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Title or Position | OWNER
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Name | BRADFORD JAY STEPHENS
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Credential | M.D.
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Telephone | 918-541-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18454
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License Number State | OK
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