Healthcare Provider Details

I. General information

NPI: 1619195195
Provider Name (Legal Business Name): MICHAEL SHAWN HOUSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 39
LEXINGTON OK
73051
US

IV. Provider business mailing address

725 SW 156TH ST
OKLAHOMA CITY OK
73170-7615
US

V. Phone/Fax

Practice location:
  • Phone: 405-527-5676
  • Fax:
Mailing address:
  • Phone: 405-703-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25279
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: