| Doctor Name: | SCOTT SHADFAR |
| NPI Number: | 1710148283 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 01072439A |
| Business Practice Address: | 4509 Integris Pkwy Suite 200 Edmond, OK - 730348696 |
| Business Phone Number: | 4056573895 |
| Business Fax Number: | 4056573896 |
| Mailing Address: | 5300 N Independence Ave, Suite 280 OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731125556 |
| Phone Number: | 4056573650 |
| Fax Number: | 4054710040 |
| NPI Enumeration Date: | 06/18/2008 |
| NPI Last Update Date: | 06/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 01072439A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |