Provider Demographics
NPI:1295734978
Name:WOODSON, STEPHEN W (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:WOODSON
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 1:907 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-1611
Mailing Address - Country:US
Mailing Address - Phone:918-967-3355
Mailing Address - Fax:918-967-8863
Practice Address - Street 1:907 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1611
Practice Address - Country:US
Practice Address - Phone:918-967-3355
Practice Address - Fax:918-967-8863
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089460AMedicaid
OKC94611Medicare UPIN
OK100089460AMedicaid