Healthcare Provider Details

I. General information

NPI: 1629060660
Provider Name (Legal Business Name): SHON WILLIAM COOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 S WESTERN AVE STE 101
OKLAHOMA CITY OK
73139-2993
US

IV. Provider business mailing address

5301 WHITE FENCES
OKLAHOMA CITY OK
73131-6603
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-6977
  • Fax: 405-701-5006
Mailing address:
  • Phone: 405-308-7482
  • Fax: 405-701-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number22474
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number24168
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: