Healthcare Provider Details

I. General information

NPI: 1790745578
Provider Name (Legal Business Name): BAPTISTE SHUNATONA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S. UTICA DT 400
TULSA OK
74104
US

IV. Provider business mailing address

1515 N HARVARD AVE SUITE E
TULSA OK
74115-4957
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2967
  • Fax: 918-293-3184
Mailing address:
  • Phone: 918-832-6049
  • Fax: 918-832-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: