Individual
DR. BRADFORD JAY STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
202 A SW, MIAMI, OK 74354
(918) 541-9400
(918) 541-9411
Mailing address
202 A SW, MIAMI, OK 74354
(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
—
37D1002186
CLIA WAIVE NUMBER
OK
01
—
5975535
AETNA PROVIDER NUMBER
OK
01
—
P00066051
RAILROD MEDICARE PROVIDER
OK
Enumeration date
06/01/2005
Last updated
03/07/2023
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