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General NPI Number Information
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NPI Number | 1962327320
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Entity Type | Organization
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Legal Business Name | SOVEREIGN PALADIN LLC
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 4101 PERIMETER CENTER DR STE 250
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2309
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Country | US
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Telephone | 866-933-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 12444 NW 10TH STREET, STE 202 BOX 175
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City | YUKON
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State | OK
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Zip | 73099-7159
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Country | US
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Telephone | 937-219-8735
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | ROBERT MARK SHIDELER
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Credential | MD
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Telephone | 937-219-8735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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