Individual
SHANE ETHAN ORR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
706 S GREATHOUSE DR, ATOKA, OK 74525
(580) 889-3553
(580) 889-4050
Mailing address
907 W OHIO AVE, COALGATE, OK 74538-1216
(580) 258-0056
(580) 889-4050
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100683770A
—
OK
Enumeration date
06/24/2014
Last updated
08/10/2015
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