Provider Demographics
NPI:1033109558
Name:THOMAS, STEPHEN HODGES (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HODGES
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-9923
Mailing Address - Country:US
Mailing Address - Phone:918-660-3831
Mailing Address - Fax:918-660-3821
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-9923
Practice Address - Country:US
Practice Address - Phone:918-660-3831
Practice Address - Fax:918-660-3821
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26764207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200255630AMedicaid
MA735424OtherTUFTS HEALTH PLAN
MA3126731Medicaid
MAJ30689OtherBCBS MA
OKOK404326Medicare PIN
OK200255630AMedicaid
MAJ30689Medicare ID - Type Unspecified
MA3126731Medicaid