Provider Demographics
NPI:1104854876
Name:DILL, STEVEN LEROY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEROY
Last Name:DILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:109 N FAIRLAND ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4203
Mailing Address - Country:US
Mailing Address - Phone:918-825-3107
Mailing Address - Fax:918-825-3128
Practice Address - Street 1:109 N FAIRLAND ST
Practice Address - Street 2:SUITE 109
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4203
Practice Address - Country:US
Practice Address - Phone:918-825-3107
Practice Address - Fax:918-825-3128
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK18074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF33983Medicare UPIN