Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25008 | OK |
N | 208600000X | Surgeon | 25008 | OK |
N | 208200000X | Surgeon | L6005 | TX |
N | 208600000X | Surgeon | L6005 | TX |
Y | 208C00000X | Colorectal Surgeon | 25008 | OK |
N | 208C00000X | Colorectal Surgeon | L6005 | TX |
NPI | 1013941418 |
---|---|
Provider Name | Shelley Capehart |
First Address | Tulsa, OK 74136-7823 |
Second Address | Tulsa, OK 74136-7823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 05/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100739880A | (05) | OK |
202408501 | (05) | TX |
I43461 | (02) | OK |