MEDICARE: DR. SHANNAN BETH BOND D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	3626	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	268321123002	OTHER	OK	BCBS OF OKLAHOMA
2	100230680A	OTHER	OK	SOONERCARE CHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1043301070	OTHER	OK	GROUP NPI NUMBER
5	3626	OTHER	OK	LICENSE NUMBER

General Provider Information

NPI Number	:	1619059466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNAN BETH BOND D.O.

Provider Business Mailing Address
First Line	:	7251 N 202ND EAST AVE
Second Line	:
City	:	OWASSO
State	:	OK
Zip	:	74055-8086
Country	:	US
Telephone Number	:	918-272-8867
Fax Number	:	918-481-8159

Provider Business Practice Location Address
First Line	:	7125 S BRADEN AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6302
Country	:	US
Telephone Number	:	918-481-8100
Fax Number	:	918-481-8159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/07/2023

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