Individual
MRS. SHANNAN LEE CARMOUCHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9800 BROADWAY EXTENSION, SUITE 203, OKLAHOMA CITY, OK 73114
(405) 419-5412
(405) 419-5468
Mailing address
9800 BROADWAY EXTENSION, SUITE 203, OKLAHOMA CITY, OK 73114
(405) 419-5412
(405) 419-5468
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
1162
OK
2086S0129X
Vascular Surgery Physician
1162
OK
363A00000X
Physician Assistant
Primary
1162
OK
363AM0700X
Medical Physician Assistant
1162
OK
Other
Enumeration date
12/27/2005
Last updated
02/03/2016
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