MEDICARE: DR. LARRY GENE STABLER MD

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	207Q00000X	Family Medicine Physician	10210	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10210	OTHER	OK	OK ST MED LIC

General Provider Information

NPI Number	:	1851467211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY GENE STABLER MD

Provider Business Mailing Address
First Line	:	4845 S SHERIDAN RD STE 509
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-5719
Country	:	US
Telephone Number	:	918-270-4309
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 S SHERIDAN RD STE 509
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-5719
Country	:	US
Telephone Number	:	918-270-4309
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/09/2007

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