Provider Demographics
NPI:1578684809
Name:TANG, SHAW M (DO)
Entity Type:Individual
Prefix:
First Name:SHAW
Middle Name:M
Last Name:TANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:802 S JACKSON AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9057
Mailing Address - Country:US
Mailing Address - Phone:918-631-8130
Mailing Address - Fax:918-631-8134
Practice Address - Street 1:802 S JACKSON AVE STE 310
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9057
Practice Address - Country:US
Practice Address - Phone:918-631-8130
Practice Address - Fax:918-631-8134
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK65082086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200785150AMedicaid
OK691847OtherMEDICARE