Provider Demographics
NPI:1679523500
Name:RICHARDS, STEVEN VANCE (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:VANCE
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 NW 63RD ST
Mailing Address - Street 2:SUITE 152
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3634
Mailing Address - Country:US
Mailing Address - Phone:405-755-6651
Mailing Address - Fax:405-755-2795
Practice Address - Street 1:4140 W MEMORIAL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8366
Practice Address - Country:US
Practice Address - Phone:405-755-1930
Practice Address - Fax:405-755-6652
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23295174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK241320411Medicare ID - Type Unspecified
H86615Medicare UPIN