Provider Demographics
NPI:1952667750
Name:QUATTLEBAUM, STEVEN CRAIG II (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CRAIG
Last Name:QUATTLEBAUM
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2017 W I 35 FRONTAGE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8555
Mailing Address - Country:US
Mailing Address - Phone:405-757-3710
Mailing Address - Fax:405-757-3711
Practice Address - Street 1:2017 W I 35 FRONTAGE RD STE 140
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8555
Practice Address - Country:US
Practice Address - Phone:405-757-3710
Practice Address - Fax:405-757-3711
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32897207Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program