| David L Shadid Do Inc | |
|
4612 S Harvard Ave Ste A Tulsa OK 74135-2908 | |
| (918) 747-5565 | |
| (918) 747-5568 |
| Full Name | David L Shadid Do Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4612 S Harvard Ave, Tulsa, Oklahoma |
| Authorized Official Name and Position | David L Shadid (PRESIDENT PHYSICIAN) |
| Authorized Official Contact | 9187475565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David L Shadid Do Inc 4612 S Harvard Ave Ste A Tulsa OK 74135-2908 Ph: (918) 747-5565 | David L Shadid Do Inc 4612 S Harvard Ave Ste A Tulsa OK 74135-2908 Ph: (918) 747-5565 |
| NPI Number | 1992898209 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 12/02/2014 |
| Medicare PECOS PAC ID | 2264482751 |
|---|---|
| Medicare Enrollment ID | O20050122000060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992898209 | NPI | - | NPPES |
| 200012860A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 2930 (Oklahoma) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 2930 (Oklahoma) | Secondary |
| Provider Name | David L Shadid |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508934126 PECOS PAC ID: 6709836299 Enrollment ID: I20050122000065 |
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