Provider Demographics
NPI:1942592886
Name:STANBRO HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:STANBRO HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STANBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-899-4945
Mailing Address - Street 1:2000 E 15TH ST
Mailing Address - Street 2:SUITE 400-A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 E 15TH ST
Practice Address - Street 2:SUITE 400-A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6697
Practice Address - Country:US
Practice Address - Phone:617-899-4945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK273532084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty