Basic Information
| Provider Information | |||||||||
| NPI: | 1538199450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5201 W MEMORIAL RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731422004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057554050 | ||||||||
| FaxNumber: | 4057499566 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 W MEMORIAL ROAD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057554050 | ||||||||
| FaxNumber: | 4057499566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 12302 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100136100A | 05 | OK | MEDICAID | 12302 | 01 | OK | LICENSE | OTHER | 080156330 | 01 | OK | RAILROAD | OTHER | 14858 | 01 | OK | OBNDD | OTHER |