Provider Demographics
NPI:1417301631
Name:FRANKLIN, SHANE DWAYNE (MD)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:DWAYNE
Last Name:FRANKLIN
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 1:608 NW 9TH ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1068
Mailing Address - Country:US
Mailing Address - Phone:405-231-3000
Mailing Address - Fax:405-272-6985
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:405-231-3000
Practice Address - Fax:405-272-6985
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine