Individual
DR. BENJAMIN ANDREW SHEPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
717 S HOUSTON AVE, SUITE 300, TULSA, OK 74127-9023
(918) 382-3100
Mailing address
2809 W MOBILE PL, BROKEN ARROW, OK 74011-7861
(423) 943-2643
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5278
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200474330A
—
OK
Enumeration date
04/08/2011
Last updated
07/30/2014
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