Provider Demographics
NPI:1013987288
Name:NUSSBAUM, STEVEN L (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9716 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7447
Mailing Address - Country:US
Mailing Address - Phone:918-299-4333
Mailing Address - Fax:918-299-4330
Practice Address - Street 1:9716 RIVERSIDE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137
Practice Address - Country:US
Practice Address - Phone:918-299-4333
Practice Address - Fax:918-299-4330
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.004602207P00000X
OK3826207PE0004X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100040600BMedicaid
OK100040600BMedicaid