Individual
DR. SHAWN MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 S MAIN ST, GROVE, OK 74344-2841
(918) 786-2243
(918) 787-3643
Mailing address
700 S MAIN ST, GROVE, OK 74344-2841
(918) 787-4200
(918) 787-4299
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
22018
OK
207Q00000X
Family Medicine Physician
Primary
22018
OK
207Q00000X
Family Medicine Physician
E-14312
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100114040A
—
OK
05
—
200059690A
—
OK
05
—
200264400A
—
OK
05
—
207446204
—
MO
Enumeration date
03/27/2006
Last updated
04/14/2023
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