Individual
SHAWN FADUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1104 WALNUT DR, ARDMORE, OK 73401-2353
(580) 226-0543
(580) 226-2284
Mailing address
1104 WALNUT DR, ARDMORE, OK 73401-2353
(580) 226-0543
(580) 226-2284
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2640
OK
Other
Enumeration date
01/19/2016
Last updated
07/21/2022
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