Provider Demographics
NPI:1700077153
Name:DISTEFANO, RONALD FRANCIS (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:FRANCIS
Last Name:DISTEFANO
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 1:3460 E 76TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8040
Mailing Address - Country:US
Mailing Address - Phone:918-481-1809
Mailing Address - Fax:918-481-1809
Practice Address - Street 1:3460 E 76TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8040
Practice Address - Country:US
Practice Address - Phone:918-481-1809
Practice Address - Fax:918-481-1809
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2431207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology