Provider Demographics
NPI:1699667709
Name:SHEGOG, ANTHONY DEWAYNE III
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DEWAYNE
Last Name:SHEGOG
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 NW COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4905
Mailing Address - Country:US
Mailing Address - Phone:580-695-3684
Mailing Address - Fax:
Practice Address - Street 1:2305 SW H AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8103
Practice Address - Country:US
Practice Address - Phone:580-699-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management