Provider Demographics
NPI:1780625756
Name:BETHEL, SHELBA J (MD)
Entity type:Individual
Prefix:
First Name:SHELBA
Middle Name:J
Last Name:BETHEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 36TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4103
Mailing Address - Country:US
Mailing Address - Phone:405-364-0643
Mailing Address - Fax:405-364-0502
Practice Address - Street 1:1139 36TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4103
Practice Address - Country:US
Practice Address - Phone:405-364-0643
Practice Address - Fax:405-364-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK8481207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK730791013001OtherBLUECROSS BLUESHEILD
OK100092930BOtherSOONERCARE
OK730791013001OtherBLUECROSS BLUESHEILD
OK100092930BOtherSOONERCARE