Provider Demographics
NPI:1073582409
Name:SHAVER, JEFFREY T (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:SHAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 SOUTH BOULEVARD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5478
Mailing Address - Country:US
Mailing Address - Phone:405-471-5252
Mailing Address - Fax:405-726-8530
Practice Address - Street 1:3840 SOUTH BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5478
Practice Address - Country:US
Practice Address - Phone:405-471-5252
Practice Address - Fax:405-726-8530
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16961207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100124540AMedicaid
OKP00392904OtherMEDICARE RAILROAD
OK100124540AMedicaid
OK249706601Medicare PIN