Provider Demographics
NPI:1578545026
Name:BANDER, STEVEN G (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:BANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2449 COUNTY ROAD 1370
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-4206
Mailing Address - Country:US
Mailing Address - Phone:214-384-1631
Mailing Address - Fax:405-265-5230
Practice Address - Street 1:217 N HARRISON AVE STE 109
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-6217
Practice Address - Country:US
Practice Address - Phone:405-888-8483
Practice Address - Fax:918-803-4861
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AW60OtherBCBS
TX114033704Medicaid
AW60OtherBCBS
080003644OtherRR MCR
TX114033703Medicaid
TX114033704Medicaid
TX114033703Medicaid
A65327Medicare UPIN