Healthcare Provider Details

I. General information

NPI: 1811251499
Provider Name (Legal Business Name): CATHERINE ANNE SHAEFFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S GARNETT RD STE 112
TULSA OK
74146-5201
US

IV. Provider business mailing address

3001 S HANOVER ST DEPT OF MEDICINE
BALTIMORE MD
21225-1233
US

V. Phone/Fax

Practice location:
  • Phone: 918-935-3550
  • Fax: 918-935-3581
Mailing address:
  • Phone: 410-350-3565
  • Fax: 410-354-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number39381
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: