Individual
DR. GREGORY ERNEST SHADID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1213 LEEPER AVE, SOUTH BEND, IN 46617-1209
(574) 302-8786
(405) 310-4417
Mailing address
1213 LEEPER AVE, SOUTH BEND, IN 46617-1209
(574) 302-8786
(405) 310-4417
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01082994A
IN
2084P0800X
Psychiatry Physician
K1056
TX
2084P0800X
Psychiatry Physician
OK20542
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100228720B
—
OK
Enumeration date
10/12/2005
Last updated
06/03/2024
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