Basic Information
| Provider Information | |||||||||
| NPI: | 1952667750 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUATTLEBAUM | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2017 W I 35 FRONTAGE RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730138555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057573710 | ||||||||
| FaxNumber: | 4057573711 | ||||||||
| Practice Location | |||||||||
| Address1: | 2017 W I 35 FRONTAGE RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730138555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057573710 | ||||||||
| FaxNumber: | 4057573711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2012 | ||||||||
| LastUpdateDate: | 11/13/2018 | ||||||||
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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 | 207Y00000X | 32897 | OK | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.