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General NPI Number Information
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NPI Number | 1013466598
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Entity Type | Individual
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Provider Name | JAYA PRASAD SHANMUGAM MD
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Gender | Male
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 3400 E FRANK PHILLIPS BLVD STE 301
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City | BARTLESVILLE
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State | OK
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Zip | 74006-2439
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Country | US
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Telephone | 918-582-6800
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Fax | 918-582-6060
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Provider Business Mailing Address
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Address Line | 2431 E 61ST ST STE 500
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City | TULSA
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State | OK
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Zip | 74136-1208
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Country | US
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Telephone | 918-582-6800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | 310210
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | R-10460
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 04-43900
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License Number State | KS
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