Provider Demographics
NPI:1932144797
Name:GREGORY E SHADID MD PLLC
Entity Type:Organization
Organization Name:GREGORY E SHADID MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:SHADID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-579-5858
Mailing Address - Street 1:3280 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-8028
Mailing Address - Country:US
Mailing Address - Phone:405-579-5858
Mailing Address - Fax:405-292-1787
Practice Address - Street 1:3280 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-8028
Practice Address - Country:US
Practice Address - Phone:405-579-5858
Practice Address - Fax:405-292-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty