Provider Demographics
NPI:1497740468
Name:HWANG, STEPHEN S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD, PHD
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 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:580-249-3003
Mailing Address - Fax:
Practice Address - Street 1:330 SOUTH 5TH STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5862
Practice Address - Country:US
Practice Address - Phone:580-249-3003
Practice Address - Fax:580-237-1480
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20382207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100034970AMedicaid
OKG58139Medicare UPIN
OH100034970AMedicaid
OKP00261477Medicare ID - Type UnspecifiedMEDICARE