Provider Demographics
NPI:1063415958
Name:LEE, STEPHEN P (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:LEE
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 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-949-3417
Mailing Address - Fax:405-552-5165
Practice Address - Street 1:3300 NW EXPRESSWAY FL 2
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-949-3417
Practice Address - Fax:405-552-5165
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK142852085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00145016OtherRAILROAD MEDICARE
OK100101280BMedicaid
OKP00145016Medicare PIN
OK244421008Medicare ID - Type Unspecified
OKMDLPL019Medicare ID - Type Unspecified
OKRADIA115Medicare ID - Type Unspecified
OKC68232Medicare UPIN
OK100101280BMedicaid
OKOKA100771Medicare PIN