Provider Demographics
NPI:1942710066
Name:CHRISTOPHER C. SHADID, MD, PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER C. SHADID, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHADID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-206-0238
Mailing Address - Street 1:PO BOX 21416
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-1416
Mailing Address - Country:US
Mailing Address - Phone:817-529-1937
Mailing Address - Fax:
Practice Address - Street 1:837 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6822
Practice Address - Country:US
Practice Address - Phone:405-206-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1508813932Medicaid