Provider Demographics
NPI:1043493190
Name:THOMAS R STOUGH MD PC
Entity Type:Organization
Organization Name:THOMAS R STOUGH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-263-7263
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:OKARCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73762-0129
Mailing Address - Country:US
Mailing Address - Phone:405-263-7263
Mailing Address - Fax:405-263-7351
Practice Address - Street 1:315 W KANSAS
Practice Address - Street 2:
Practice Address - City:OKARCHE
Practice Address - State:OK
Practice Address - Zip Code:73762
Practice Address - Country:US
Practice Address - Phone:405-263-7263
Practice Address - Fax:405-263-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9050208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35317Medicare UPIN