Provider Demographics
NPI:1013937911
Name:STOESSER, BRUCE CARLTON (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:CARLTON
Last Name:STOESSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 E 48TH ST S
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5830
Mailing Address - Country:US
Mailing Address - Phone:918-749-8765
Mailing Address - Fax:918-392-2155
Practice Address - Street 1:10901 E 48TH ST S
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5830
Practice Address - Country:US
Practice Address - Phone:918-749-8765
Practice Address - Fax:918-392-2155
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10459208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100046040AMedicaid
OK100046040AMedicaid