Healthcare Provider Details

I. General information

NPI: 1427031863
Provider Name (Legal Business Name): BRYAN M SHEEHAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NEO LOOP STE A
GROVE OK
74344
US

IV. Provider business mailing address

PO BOX 452327
GROVE OK
74345-2327
US

V. Phone/Fax

Practice location:
  • Phone: 918-787-6893
  • Fax: 918-787-6815
Mailing address:
  • Phone: 918-787-6893
  • Fax: 918-787-6815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number234
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number207
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: