Provider Demographics
NPI:1508817420
Name:SHURLEY, TOM H (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:H
Last Name:SHURLEY
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 1:304 S PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5718
Mailing Address - Country:US
Mailing Address - Phone:580-379-6530
Mailing Address - Fax:580-379-6509
Practice Address - Street 1:304 S PARK LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5718
Practice Address - Country:US
Practice Address - Phone:580-477-7355
Practice Address - Fax:580-482-7510
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10579207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100156750AMedicaid
OKC95496Medicare UPIN