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General NPI Number Information
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NPI Number | 1992898209
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Entity Type | Organization
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Legal Business Name | DAVID L SHADID DO INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 4612 S HARVARD AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-2908
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Country | US
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Telephone | 918-747-5565
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Fax | 918-747-5568
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Provider Business Mailing Address
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Address Line | 4612 S HARVARD AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-2908
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Country | US
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Telephone | 918-747-5565
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Fax | 918-747-5568
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | MR. DAVID L SHADID
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Credential | DO
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Telephone | 918-747-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2930
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2930
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License Number State | OK
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