MEDICARE: BRADFORD JAY STEPHENS MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	18454	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DH0106	OTHER		MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	136644648	OTHER	OK	NPI NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5975535	OTHER	OK	AETNA PROVIDER NUMBER
5	G43709	OTHER	OK	UPIN
6	37D1002186	OTHER	OK	CLIA WAIVE NUMBER

General Provider Information

NPI Number	:	1316006562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADFORD JAY STEPHENS MD PC

Provider Business Mailing Address
First Line	:	202 A SW
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354-7604
Country	:	US
Telephone Number	:	918-541-9400
Fax Number	:	918-541-9411

Provider Business Practice Location Address
First Line	:	202 A SW
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354-6708
Country	:	US
Telephone Number	:	918-541-9400
Fax Number	:	918-541-9411

Authorized Official
Title or Position	:	OWNER
Name	:	BRADFORD JAY STEPHENS
Credential	:	M.D.
Telephone Number	:	918-541-9400

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	03/07/2023

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Directions to “BRADFORD JAY STEPHENS MD PC ” Practice Location

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