Basic Information
| Provider Information | |||||||||
| NPI: | 1508813932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHADID | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26168 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731260168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059478585 | ||||||||
| FaxNumber: | 4059486507 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 WILL ROGERS PKWY | ||||||||
| Address2: | 105 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731081837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059512815 | ||||||||
| FaxNumber: | 4059486507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 04/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 22933 | OK | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200056890A | 05 | OK | MEDICAID | 731451967001 | 01 | BCBS GRP BILLING # | OTHER |