Provider Demographics
NPI:1619059466
Name:BOND, SHANNAN BETH (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANNAN
Middle Name:BETH
Last Name:BOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7251 N 202ND EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8086
Mailing Address - Country:US
Mailing Address - Phone:918-272-8867
Mailing Address - Fax:918-481-8159
Practice Address - Street 1:7125 S BRADEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6302
Practice Address - Country:US
Practice Address - Phone:918-481-8100
Practice Address - Fax:918-481-8159
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3626208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK268321123002OtherBCBS OF OKLAHOMA
OK100230680AOtherSOONERCARE CHOICE
OK100187850BMedicaid
OK1043301070OtherGROUP NPI NUMBER
OK3626OtherLICENSE NUMBER
OKBB6428329OtherDEA NUMBER
OK731474926OtherTAX ID NUMBER