Provider Demographics
NPI:1336102342
Name:YAMANE, SHANE S (MD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:S
Last Name:YAMANE
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 1:802 S JACKSON AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9049
Mailing Address - Country:US
Mailing Address - Phone:918-582-7711
Mailing Address - Fax:918-583-5831
Practice Address - Street 1:802 S JACKSON AVE STE 225
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127
Practice Address - Country:US
Practice Address - Phone:918-582-7711
Practice Address - Fax:918-583-5831
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30044208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK555969YLFBOtherMEDICARE
OK200525770AMedicaid
HIH100623Medicare ID - Type Unspecified