Provider Demographics
NPI:1316951726
Name:AUTRY, STEPHEN T (MD,MBA)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T
Last Name:AUTRY
Suffix:
Gender:M
Credentials:MD,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8099 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2231
Mailing Address - Country:US
Mailing Address - Phone:513-793-3933
Mailing Address - Fax:513-793-8299
Practice Address - Street 1:8099 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2231
Practice Address - Country:US
Practice Address - Phone:513-793-3933
Practice Address - Fax:513-793-8299
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-1944-A207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0455323Medicaid
OH200011776OtherMEDICARE RAILROAD
OHA14898Medicare UPIN
OH200011776OtherMEDICARE RAILROAD