Basic Information
| Provider Information | |||||||||
| NPI: | 1023496940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHONEY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 N INDEPENDENCE AVE STE 280 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057139935 | ||||||||
| FaxNumber: | 4057139936 | ||||||||
| Practice Location | |||||||||
| Address1: | 3433 NW 56TH ST STE 900 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057139935 | ||||||||
| FaxNumber: | 4057139936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2015 | ||||||||
| LastUpdateDate: | 05/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208C00000X | 39325 | OK | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | D0091959 | MD | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.