Provider Demographics
NPI:1386761641
Name:LEVINE, STEPHEN JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JACOB
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22491 HIGH RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-6392
Mailing Address - Country:US
Mailing Address - Phone:405-919-9524
Mailing Address - Fax:405-598-5007
Practice Address - Street 1:22491 HIGH RIDGE LN
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-6392
Practice Address - Country:US
Practice Address - Phone:405-919-9524
Practice Address - Fax:405-919-9524
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK11477207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine