Provider Demographics
NPI:1326092370
Name:CONNALLY, TOM SHI (MD)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:SHI
Last Name:CONNALLY
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:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6668
Mailing Address - Fax:405-307-6660
Practice Address - Street 1:500 EAST ROBINSON
Practice Address - Street 2:SUITE 2300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6671
Practice Address - Country:US
Practice Address - Phone:405-329-4102
Practice Address - Fax:405-307-5627
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200014890BMedicaid
OKP00072417OtherMEDICARE RAILROAD
OK200014890AMedicaid
OK200014890AMedicaid
OK800522290Medicare PIN
OK249730501Medicare PIN
H90725Medicare UPIN