Provider Demographics
NPI:1952390361
Name:STEARNS, FREDERIC WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:WILLIAM
Last Name:STEARNS
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 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-307-0215
Mailing Address - Fax:918-250-7669
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:STE 335
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-307-0215
Practice Address - Fax:918-250-7669
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11891207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicare PIN
C95521Medicare UPIN