Provider Demographics
NPI:1477553105
Name:STOCKETT, MARY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:STOCKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7301 N COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6646
Mailing Address - Country:US
Mailing Address - Phone:405-721-8090
Mailing Address - Fax:405-722-8529
Practice Address - Street 1:7301 N COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-6646
Practice Address - Country:US
Practice Address - Phone:405-721-8090
Practice Address - Fax:405-722-8529
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK19659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics