Provider Demographics
NPI:1225293012
Name:STUMPH, SAVANNAH DELK (DO)
Entity Type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:DELK
Last Name:STUMPH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:DELK
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 W 15TH ST
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3747
Mailing Address - Country:US
Mailing Address - Phone:405-471-5800
Mailing Address - Fax:405-471-5861
Practice Address - Street 1:416 W 15TH ST
Practice Address - Street 2:BUILDING 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3666
Practice Address - Country:US
Practice Address - Phone:405-471-5800
Practice Address - Fax:405-471-5861
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200255700AMedicaid