STILLWATER SKIN & CANCER MEDICAL CLINIC, INC
NPI 1790839900
Specialist in Stillwater, OK

Q: What is Stillwater Skin & Cancer Medical Clinic, Inc's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since January 23, 2007

1604 W 8TH AVE, STILLWATER, OK 74074(405) 624-1077(405) 377-2273 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jul 21, 2022, Mar 17, 2018, Aug 7, 2017 (3 updates tracked since 2017).

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About Stillwater Skin & Cancer Medical Clinic, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STILLWATER SKIN & CANCER MEDICAL CLINIC, INC (NPI 1790839900) is a healthcare organization registered as a specialist in Stillwater, Oklahoma and active in the NPI registry since January 2007. The organization maintains a secondary practice location in Ponca City and lists Robert A Breedlove, Owner, as its authorized official.

NPPES Registry Identity

NPI1790839900

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameSTILLWATER SKIN & CANCER MEDICAL CLINIC, INC

Location Address1604 W 8TH AVEStillwater, OK 74074-4207

Mailing AddressPo Box 108809Oklahoma City, OK 73101-8809 · (405) 624-1077 · Fax (405) 377-2273

Phone(405) 624-1077

Fax(405) 377-2273

Organization SubpartNo

Authorized OfficialRobert A BreedloveOwner · (405) 624-1077

Enumeration DateJanuary 23, 2007

Last NPPES UpdateJuly 21, 20223 updates tracked since enumeration

✔ NPI 1790839900 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in OK · 10612

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

1604 W 8TH AVE, Stillwater, OK 74074

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Secondary Practice Location 1

Location 11722 N 4th StPonca City, OK 74601-2745 · Phone (405) 624-1077 · Fax (405) 377-2273

Other Identifiers 2

Other1588609606OK · Npi

Other1790839900OK · Group Npi

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stillwater Skin & Cancer Medical Clinic, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Stillwater Skin & Cancer Medical Clinic, Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Robert Breedlove, M.D., FAAD

Dermatology

NPI 1588609606

1604 W 8TH AVE
Stillwater, OK 74074

(405) 624-1077

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stillwater Skin & Cancer Medical Clinic, Inc's NPI number?

The NPI number for Stillwater Skin & Cancer Medical Clinic, Inc is 1790839900. It was assigned to this organization in the NPPES registry on January 23, 2007.

Where is Stillwater Skin & Cancer Medical Clinic, Inc located?

Stillwater Skin & Cancer Medical Clinic, Inc is located at 1604 W 8th Ave, Stillwater, OK 74074. The listed phone number is (405) 624-1077.

What is Stillwater Skin & Cancer Medical Clinic, Inc's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Stillwater Skin & Cancer Medical Clinic, Inc enrolled in Medicare?

Yes. Stillwater Skin & Cancer Medical Clinic, Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Stillwater Skin & Cancer Medical Clinic, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Stillwater Skin & Cancer Medical Clinic, Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Stillwater Skin & Cancer Medical Clinic, Inc was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.