Provider Demographics
NPI:1316635543
Name:STANDFILL, JOHN DEAN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DEAN
Last Name:STANDFILL
Suffix:
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 1:800 W CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7807
Mailing Address - Country:US
Mailing Address - Phone:405-230-0133
Mailing Address - Fax:
Practice Address - Street 1:800 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7807
Practice Address - Country:US
Practice Address - Phone:405-230-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist