Provider Demographics
NPI:1598119109
Name:K. ANTHONY SHANBOUR MD INC
Entity Type:Organization
Organization Name:K. ANTHONY SHANBOUR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:K.
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SHANBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-237-9878
Mailing Address - Street 1:13921 N MERIDIAN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1104
Mailing Address - Country:US
Mailing Address - Phone:405-237-9878
Mailing Address - Fax:405-655-5791
Practice Address - Street 1:5720 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2010
Practice Address - Country:US
Practice Address - Phone:405-470-2207
Practice Address - Fax:405-470-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17067207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty