Provider Demographics
NPI:1932116282
Name:REED, SHANON LEIGH (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANON
Middle Name:LEIGH
Last Name:REED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9065 HARMONY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5239
Mailing Address - Country:US
Mailing Address - Phone:405-733-5800
Mailing Address - Fax:405-733-5913
Practice Address - Street 1:9065 HARMONY DRIVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5239
Practice Address - Country:US
Practice Address - Phone:405-733-5800
Practice Address - Fax:405-733-5913
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH36768Medicare UPIN