Individual
DR. PATTI WANNETTA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
9228 S. MINGO, SUITE 103, TULSA, OK 74133-5721
(918) 392-7575
(918) 615-3465
Mailing address
9228 S MINGO RD, STE 103, TULSA, OK 74133-5718
(918) 392-7575
(918) 615-3465
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3601
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100132300A
—
OK
Enumeration date
07/04/2006
Last updated
05/06/2014
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