Organization
STILLWATER SKIN & CANCER MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT A BREEDLOVE M.D., F.A.AD. (OWNER)
(405) 624-1077
Entity
Organization
Contact information
Practice address
1604 W 8TH AVE, STILLWATER, OK 74074-4207
(405) 624-1077
(405) 377-2273
Mailing address
PO BOX 108809, OKLAHOMA CITY, OK 73101-8809
(405) 624-1077
(405) 377-2273
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10612
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588609606
NPI
OK
01
—
1790839900
GROUP NPI
OK
Enumeration date
01/23/2007
Last updated
07/21/2022
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