Provider Demographics
NPI:1609811801
Name:STEVENSON, ROBIN LINDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LINDELL
Last Name:STEVENSON
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 1:100 REMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4168
Mailing Address - Country:US
Mailing Address - Phone:918-457-9017
Mailing Address - Fax:
Practice Address - Street 1:2230 US HWY 412
Practice Address - Street 2:
Practice Address - City:COLCORD
Practice Address - State:OK
Practice Address - Zip Code:74338-4168
Practice Address - Country:US
Practice Address - Phone:918-422-5750
Practice Address - Fax:918-422-4351
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12183207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D35313Medicare UPIN