Provider Demographics
NPI:1053300483
Name:CAGLE, STEPHEN KEITH (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KEITH
Last Name:CAGLE
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 1:4120 W MEMORIAL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9322
Mailing Address - Country:US
Mailing Address - Phone:405-748-3300
Mailing Address - Fax:405-748-2920
Practice Address - Street 1:4120 W MEMORIAL RD
Practice Address - Street 2:STE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9322
Practice Address - Country:US
Practice Address - Phone:405-748-3300
Practice Address - Fax:405-748-2920
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10845174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C94743Medicare UPIN