MEDICARE: DR. JEFFREY LEE SHIPMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	4436	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982618575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LEE SHIPMAN D.O.

Provider Business Mailing Address
First Line	:	1132 SW 127TH PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-6950
Country	:	US
Telephone Number	:	405-703-0743
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 S DOUGLAS AVE STE 306
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3215
Country	:	US
Telephone Number	:	405-636-7195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/03/2009

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