Provider Demographics
NPI:1770530107
Name:SHIRLEY, LARRY D (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:SHIRLEY
Suffix:
Gender:M
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:PO BOX 26168
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0168
Mailing Address - Country:US
Mailing Address - Phone:405-947-8585
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:4400 WILL ROGERS PKWY
Practice Address - Street 2:105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1837
Practice Address - Country:US
Practice Address - Phone:405-951-2815
Practice Address - Fax:405-948-6507
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16877207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
731451967001OtherBCBS GRP BILLING #
OK1000117410AMedicaid
OK45448766RMedicare ID - Type Unspecified
OK1000117410AMedicaid