Healthcare Provider Details

I. General information

NPI: 1225650831
Provider Name (Legal Business Name): JOSHUA CALEB SHAHBANDEH MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 NE LAWRIE TATUM RD
LAWTON OK
73507-3099
US

IV. Provider business mailing address

3804 S BUTTERNUT AVE
BROKEN ARROW OK
74011-1269
US

V. Phone/Fax

Practice location:
  • Phone: 580-354-5000
  • Fax:
Mailing address:
  • Phone: 918-695-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number47114
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: