Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 33355 | OK |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 33355 | OK |
NPI | 1043453103 |
---|---|
Provider Name | Dr. Mark C Shreve |
First Address | Oklahoma City, OK 73114-7408 |
Second Address | Oklahoma City, OK 73114-7408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2009 |
Last Update Date | 25/06/2019 |