Individual
JAYA PRASAD SHANMUGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 E FRANK PHILLIPS BLVD STE 301, BARTLESVILLE, OK 74006-2439
(918) 582-6800
(918) 582-6060
Mailing address
2431 E 61ST ST STE 500, TULSA, OK 74136-1208
(918) 582-6800
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
310210
LA
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
R-10460
IA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
04-43900
KS
Other
Enumeration date
09/26/2016
Last updated
11/07/2024
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