Provider Demographics
NPI:1972764496
Name:GREWAL, SHAUN GOBIND SINGH (MD)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:GOBIND SINGH
Last Name:GREWAL
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 1:10901 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5830
Mailing Address - Country:US
Mailing Address - Phone:918-749-8765
Mailing Address - Fax:918-392-2155
Practice Address - Street 1:10901 E 48TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5830
Practice Address - Country:US
Practice Address - Phone:918-749-8765
Practice Address - Fax:918-392-2155
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016448208600000X
OK29661208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery