Doctor Name: | SHANE ETHAN ORR |
NPI Number: | 1134534696 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 706 S Greathouse Dr Atoka, OK - 74525 |
Business Phone Number: | 5808893553 |
Business Fax Number: | 5808894050 |
Mailing Address: | 907 W Ohio Ave, COALGATE |
State: | OK |
Postal Code: | 745381216 |
Phone Number: | 5802580056 |
Fax Number: | 5808894050 |
NPI Enumeration Date: | 06/24/2014 |
NPI Last Update Date: | 08/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |