Provider Demographics
NPI:1760485643
Name:STOKES, KENNETH R (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:STOKES
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 1:5300 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:405-949-3417
Mailing Address - Fax:405-552-5165
Practice Address - Street 1:3300 NW EXPRESSWAY FL 2
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-949-3417
Practice Address - Fax:405-552-5165
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK188572085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100181120AMedicaid
OKP00144991OtherRAILROAD MEDICARE
OK244421012Medicare ID - Type Unspecified
OKP00144991Medicare PIN
OKP00144991OtherRAILROAD MEDICARE
OK2RADIA016Medicare ID - Type Unspecified
OKB99172Medicare UPIN
OKOKA101981Medicare PIN
OK100181120AMedicaid
OKA102091Medicare PIN