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General NPI Number Information
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NPI Number | 1366025207
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Entity Type | Individual
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Provider Name | STACY PHILIP MD
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Gender | Female
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 3138 S GARNETT RD
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City | TULSA
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State | OK
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Zip | 74146-1933
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Country | US
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Telephone | 918-203-7005
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Fax | 918-400-0967
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Provider Business Mailing Address
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Address Line | 1200 W CHEROKEE ST
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City | WAGONER
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State | OK
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Zip | 74467-4624
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Country | US
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Telephone | 918-485-5514
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 38292
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38292
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License Number State | OK
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