MEDICARE: STEPHEN JOSEPH BRASSEUX M.D.

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	2084P0800X	Psychiatry Physician	E-6485	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	704532	OTHER	OK	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790867687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN JOSEPH BRASSEUX M.D.

Provider Business Mailing Address
First Line	:	5310 E 31ST ST FL 13
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-5018
Country	:	US
Telephone Number	:	918-561-5701
Fax Number	:	918-561-1173

Provider Business Practice Location Address
First Line	:	5310 E 31ST ST FL LL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-5018
Country	:	US
Telephone Number	:	918-236-4000
Fax Number	:	918-236-4001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	05/12/2021

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