Provider Demographics
NPI:1508934126
Name:SHADID, DAVID L (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SHADID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4612 S HARVARD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2908
Mailing Address - Country:US
Mailing Address - Phone:918-747-5565
Mailing Address - Fax:918-747-5568
Practice Address - Street 1:4612 S HARVARD
Practice Address - Street 2:STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-747-5565
Practice Address - Fax:918-747-5568
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29302084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100129510AMedicaid
OKE46779Medicare UPIN
OK100129510AMedicaid