Provider Demographics
NPI:1215529243
Name:ORTMAN, STEVEN DOUGLAS JR
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:ORTMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 S URBANA STREET
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5997
Mailing Address - Country:US
Mailing Address - Phone:918-710-4112
Mailing Address - Fax:918-710-4118
Practice Address - Street 1:11912 S NORWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-5547
Practice Address - Country:US
Practice Address - Phone:918-943-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF11200788363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care