Provider Demographics
NPI:1306860820
Name:GAWEY, STEPHEN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:GAWEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21052
Mailing Address - Street 2:LOCKBOX 22410
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1052
Mailing Address - Country:US
Mailing Address - Phone:918-742-0552
Mailing Address - Fax:918-747-3177
Practice Address - Street 1:1819 E 19TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5414
Practice Address - Country:US
Practice Address - Phone:918-742-0552
Practice Address - Fax:918-747-3177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK12708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100095100AMedicaid
OK100095100AMedicaid