Provider Demographics
NPI:1568455772
Name:DITTO, STEVEN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:DITTO
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 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-702-9400
Mailing Address - Fax:405-702-9437
Practice Address - Street 1:4801 SE 15TH ST STE 300
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3918
Practice Address - Country:US
Practice Address - Phone:405-702-9400
Practice Address - Fax:405-702-9437
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100846180AMedicaid
OK100846180AMedicaid
G58314Medicare UPIN