Healthcare Provider Details

I. General information

NPI: 1508817420
Provider Name (Legal Business Name): TOM H SHURLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S PARK LN
ALTUS OK
73521-5718
US

IV. Provider business mailing address

304 S PARK LN
ALTUS OK
73521-5718
US

V. Phone/Fax

Practice location:
  • Phone: 580-477-7355
  • Fax: 580-482-7510
Mailing address:
  • Phone: 580-379-6530
  • Fax: 580-379-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10579
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: