Basic Information
| Provider Information | |||||||||
| NPI: | 1700887494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINDSEY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 N PORTER AVE | ||||||||
| Address2: | SUITE #300 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053290121 | ||||||||
| FaxNumber: | 4052926099 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 N PORTER AVE | ||||||||
| Address2: | SUITE #300 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053290121 | ||||||||
| FaxNumber: | 4052926099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 06/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 13490 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4011336 | 01 | OK | AETNA EDI # | OTHER | 731297740003 | 01 | OK | BLUE CROSS BLUE SHIELD | OTHER | 080085562 | 01 | OK | RAILROAD MEDICARE | OTHER | 100136440A | 05 | OK | MEDICAID |