Provider Demographics
NPI:1760485718
Name:STEPHENS, BRIAN T (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:STEPHENS
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 1:12455 E 100TH ST N STE 350
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4675
Mailing Address - Country:US
Mailing Address - Phone:918-274-5555
Mailing Address - Fax:
Practice Address - Street 1:12455 E 100TH ST N STE 350
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4675
Practice Address - Country:US
Practice Address - Phone:918-247-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD2001008551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2000096869OtherBNDD
MO205405707Medicaid
MOBS7289451OtherDEA
MOBS7289451OtherDEA