Provider Demographics
NPI:1245239045
Name:MADRID, STEVE M (PA)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:M
Last Name:MADRID
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-0727
Mailing Address - Country:US
Mailing Address - Phone:580-430-3333
Mailing Address - Fax:580-430-3305
Practice Address - Street 1:800 SHARE DR
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-3618
Practice Address - Country:US
Practice Address - Phone:580-430-3366
Practice Address - Fax:580-430-3354
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK870 PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100203340AMedicaid