Provider Demographics
NPI:1346237732
Name:CAMPBELL, STEPHEN BILL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BILL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 1654
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:405-947-8586
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:9423 E 95TH CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5805
Practice Address - Country:US
Practice Address - Phone:918-496-2400
Practice Address - Fax:405-948-6507
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9019207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0277797001OtherCIGNA
OK0277797001OtherCIGNA
P00338728Medicare PIN