Provider Demographics
NPI:1972860617
Name:FITZGERALD, SHAWN ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ROBERT
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-364-0555
Mailing Address - Fax:405-573-5483
Practice Address - Street 1:700 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6232
Practice Address - Country:US
Practice Address - Phone:405-364-0555
Practice Address - Fax:405-573-5483
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5376207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program