Organization
BRADFORD JAY STEPHENS MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADFORD JAY STEPHENS M.D. (OWNER)
(918) 541-9400
Entity
Organization
Contact information
Practice address
202 A SW, MIAMI, OK 74354-6708
(918) 541-9400
(918) 541-9411
Mailing address
202 A SW, MIAMI, OK 74354-7604
(918) 541-9400
(918) 541-9411
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18454
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100048810A
—
OK
01
—
136644648
NPI NUMBER
OK
01
—
37D1002186
CLIA WAIVE NUMBER
OK
01
—
5975535
AETNA PROVIDER NUMBER
OK
01
—
DH0106
MEDICARE RAIL ROAD
—
01
—
G43709
UPIN
OK
Enumeration date
12/06/2006
Last updated
03/07/2023
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