Healthcare Provider Details

I. General information

NPI: 1508934126
Provider Name (Legal Business Name): DAVID L SHADID DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 S HARVARD STE A
TULSA OK
74135
US

IV. Provider business mailing address

4612 S HARVARD AVE STE A
TULSA OK
74135-2908
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-5565
  • Fax: 918-747-5568
Mailing address:
  • Phone: 918-747-5565
  • Fax: 918-747-5568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2930
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2930
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: