Individual
SHANNON KYLE KANEASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5701 N PORTLAND AVE, SUITE 305, OKLAHOMA CITY, OK 73112-1678
(405) 604-4475
(405) 604-4480
Mailing address
3033 NW 63RD ST, SUITE 152, OKLAHOMA CITY, OK 73116-3634
(405) 755-6651
(405) 607-3559
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
22929
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200172670A
—
OK
Enumeration date
02/05/2007
Last updated
06/01/2016
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