Provider Demographics
NPI:1013941418
Name:CAPEHART, SHELLEY (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:CAPEHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-481-4800
Mailing Address - Fax:918-481-4826
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-481-4800
Practice Address - Fax:918-481-4826
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6005208600000X, 208C00000X
OK25008208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100739880AMedicaid
TX202408501Medicaid
OK248628204Medicare PIN
TX613823Medicare PIN
TX202408501Medicaid