Provider Demographics
NPI:1649366998
Name:ARDOIN, STANLEY P (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:P
Last Name:ARDOIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 NW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7118
Mailing Address - Country:US
Mailing Address - Phone:405-842-2323
Mailing Address - Fax:405-573-3960
Practice Address - Street 1:3280 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-8022
Practice Address - Country:US
Practice Address - Phone:405-579-5858
Practice Address - Fax:405-292-1787
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK177302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100083650AMedicaid
F24152Medicare UPIN
OK100083650AMedicaid