Provider Demographics
NPI:1447384540
Name:SHELBA J BETHEL MD INC
Entity Type:Organization
Organization Name:SHELBA J BETHEL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELBA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:405-364-5725
Mailing Address - Street 1:809 N FINDLAY AVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071
Mailing Address - Country:US
Mailing Address - Phone:405-364-0643
Mailing Address - Fax:405-364-0502
Practice Address - Street 1:809 N FINDLAY AVE
Practice Address - Street 2:100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6438
Practice Address - Country:US
Practice Address - Phone:405-364-0643
Practice Address - Fax:405-364-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100092930BMedicaid
OK100092930BMedicaid
OK245718301Medicare PIN