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Individual

DR. SHANNAN BETH BOND

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
7125 S BRADEN AVE, TULSA, OK 74136-6302
(918) 481-8100
(918) 481-8159
Mailing address
7251 N 202ND EAST AVE, OWASSO, OK 74055-8086
(918) 272-8867
(918) 481-8159

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
3626
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100187850B
OK
01
100230680A
SOONERCARE CHOICE
OK
01
1043301070
GROUP NPI NUMBER
OK
01
268321123002
BCBS OF OKLAHOMA
OK
01
3626
LICENSE NUMBER
OK
Enumeration date
10/20/2006
Last updated
03/07/2023
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