Provider Demographics
NPI:1700850369
Name:SHANBOUR, KAMAL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:ANTHONY
Last Name:SHANBOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13291 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 1:4140 W MEMORIAL RD
Practice Address - Street 2:SUITE 215
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8366
Practice Address - Country:US
Practice Address - Phone:405-242-4030
Practice Address - Fax:405-242-4031
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17067207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100095810AMedicaid
OKF18334Medicare UPIN
700522165Medicare ID - Type Unspecified