Provider Demographics
NPI:1225068521
Name:STEPHEN C. GAUTHIER M.D. PC
Entity Type:Organization
Organization Name:STEPHEN C. GAUTHIER M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-842-3792
Mailing Address - Street 1:6516 N OLIE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7226
Mailing Address - Country:US
Mailing Address - Phone:405-286-5606
Mailing Address - Fax:405-286-5607
Practice Address - Street 1:6516 N OLIE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7226
Practice Address - Country:US
Practice Address - Phone:405-286-5606
Practice Address - Fax:405-286-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21236208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty