Provider Demographics
NPI:1992898209
Name:DAVID L SHADID DO INC
Entity type:Organization
Organization Name:DAVID L SHADID DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHADID
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-747-5565
Mailing Address - Street 1:4612 S HARVARD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2908
Mailing Address - Country:US
Mailing Address - Phone:918-747-5565
Mailing Address - Fax:918-747-5568
Practice Address - Street 1:4612 S HARVARD AVE
Practice Address - Street 2:STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2908
Practice Address - Country:US
Practice Address - Phone:918-747-5565
Practice Address - Fax:918-747-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29302084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200012860AMedicaid
OK200012860AMedicaid
OK242329000Medicare UPIN