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General NPI Number Information
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NPI Number | 1396636031
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Entity Type | Organization
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Legal Business Name | SHADFAR FACIAL PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 4509 INTEGRIS PKWY STE 350
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City | EDMOND
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State | OK
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Zip | 73034-8696
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Country | US
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Telephone | 405-534-4358
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Fax | 405-657-3896
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Provider Business Mailing Address
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Address Line | 225 NATURE LN
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City | EDMOND
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State | OK
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Zip | 73034-3461
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SCOTT SHADFAR
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Credential | MD
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Telephone | 405-834-3275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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