Provider Demographics
NPI:1447299920
Name:TREADWELL, STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:TREADWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-0276
Mailing Address - Country:US
Mailing Address - Phone:580-229-0313
Mailing Address - Fax:580-229-2045
Practice Address - Street 1:11053 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438-1721
Practice Address - Country:US
Practice Address - Phone:580-229-0313
Practice Address - Fax:580-229-2045
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E71558Medicare UPIN