Organization
ID CONSULTANTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN WHITE (MANAGER)
(502) 212-9393
Entity
Organization
Contact information
Practice address
8609 WILLOW SPRINGS CT, BROKEN ARROW, OK 74011-8250
(918) 361-2825
(770) 573-9513
Mailing address
8609 WILLOW SPRINGS CT, BROKEN ARROW, OK 74011-8250
(918) 361-2825
(770) 573-9513
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
24139
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200037750A
—
OK
01
—
24139
STATE LICENSE
OK
Enumeration date
12/12/2014
Last updated
02/12/2015
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