Provider Demographics
NPI:1942260013
Name:SHURLEY, PHILIP SHERWOOD (PA-C)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:SHERWOOD
Last Name:SHURLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268981
Mailing Address - Street 2:MCBRIDE CLINIC, INC.
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8981
Mailing Address - Country:US
Mailing Address - Phone:405-230-9000
Mailing Address - Fax:405-230-9175
Practice Address - Street 1:1110 N LEE AVE
Practice Address - Street 2:MCBRIDE CLINIC, INC.
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2612
Practice Address - Country:US
Practice Address - Phone:405-230-9000
Practice Address - Fax:405-230-9421
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200022820AMedicaid
OK200022820AMedicaid