Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 12744 | OK |
Y | 208600000X | Surgeon | 12744 | OK |
NPI | 1023016268 |
---|---|
Provider Name | Dr. Teresa Marie Shavney |
First Address | Oklahoma City, OK 73112-4493 |
Second Address | Oklahoma City, OK 73112-4493 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100112140A | (05) | OK |