Provider Demographics
NPI:1134171648
Name:GAUTHIER, STEPHEN COLE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:COLE
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6516 N OLIE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7226
Mailing Address - Country:US
Mailing Address - Phone:405-286-5606
Mailing Address - Fax:405-286-5607
Practice Address - Street 1:6516 N OLIE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7226
Practice Address - Country:US
Practice Address - Phone:405-286-5606
Practice Address - Fax:405-286-5607
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK21236208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery