Healthcare Provider Details

I. General information

NPI: 1710148283
Provider Name (Legal Business Name): SCOTT SHADFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9433 N KELLEY AVE
OKLAHOMA CITY OK
73131-2415
US

IV. Provider business mailing address

9433 N KELLEY AVE
OKLAHOMA CITY OK
73131-2415
US

V. Phone/Fax

Practice location:
  • Phone: 405-871-5757
  • Fax: 405-242-0031
Mailing address:
  • Phone: 405-871-5757
  • Fax: 405-242-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number31708
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: