Provider Demographics
NPI:1649410549
Name:STABNICK, PETER BRICE (BS)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:BRICE
Last Name:STABNICK
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 S LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4504
Mailing Address - Country:US
Mailing Address - Phone:918-260-2209
Mailing Address - Fax:918-241-5031
Practice Address - Street 1:2 N WATER ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2816
Practice Address - Country:US
Practice Address - Phone:918-224-0225
Practice Address - Fax:918-224-5975
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program