Provider Demographics
NPI:1184616070
Name:CONNERY, STEPHEN E (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:CONNERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:950 N PORTER AVE
Mailing Address - Street 2:SUITE300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6400
Mailing Address - Country:US
Mailing Address - Phone:405-329-0121
Mailing Address - Fax:405-292-6099
Practice Address - Street 1:950 N PORTER AVE
Practice Address - Street 2:SUITE300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6400
Practice Address - Country:US
Practice Address - Phone:405-329-0121
Practice Address - Fax:405-292-6099
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKMD16184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4077136OtherAETNA EDI
OK100107930AMedicaid
OK080085561OtherRAILROAD MEDICARE
OK4077136OtherAETNA EDI