Provider Demographics
NPI:1922056662
Name:KATZ, STEPHEN JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JEROME
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1425 E LINCOLN RD
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7345
Mailing Address - Country:US
Mailing Address - Phone:580-286-2947
Mailing Address - Fax:580-286-8287
Practice Address - Street 1:1425 E LINCOLN RD
Practice Address - Street 2:SUITE A-6
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7345
Practice Address - Country:US
Practice Address - Phone:580-286-2947
Practice Address - Fax:580-286-8287
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2013-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK9207208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery