Organization
JEFFREY R SHUART MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY R SHUART MD (PRESIDENT)
(580) 363-0052
Entity
Organization
Contact information
Practice address
115 W BRIDGE AVE, BLACKWELL, OK 74631-2800
(580) 363-3501
(580) 363-3477
Mailing address
115 W BRIDGE AVE, BLACKWELL, OK 74631-2800
(580) 363-3501
(580) 363-3477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18498
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100751170A
—
OK
Enumeration date
02/22/2007
Last updated
10/10/2016
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