Healthcare Provider Details

I. General information

NPI: 1023004132
Provider Name (Legal Business Name): DR. GERARD FRANCIS SHEA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 GRANDVIEW AVE
PAWHUSKA OK
74056-3201
US

IV. Provider business mailing address

900 MONUMENT RD
PONCA CITY OK
74604-3616
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-4491
  • Fax:
Mailing address:
  • Phone: 580-765-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1720
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: