Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 6549 | OK |
NPI | 1144588559 |
---|---|
Provider Name | Dr. Gregory Farris Shanbour |
First Address | Oklahoma City, OK 73139-9476 |
Second Address | Oklahoma City, OK 73139-9476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 25/10/2019 |