Active NPI
Ronald Wayne Shreck, M.D.
- Surgery Physician
- Enid, OK
National Provider Identifier
1326154394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 11370
- Practice address
- 407 E Cherokee Ave
Enid, OK 73701-5814 - Phone
- (580) 242-7020
- Fax
- (580) 233-1617
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 11370 | OK | Primary |
Addresses
Primary practice location
407 E Cherokee Ave
Enid, OK 73701-5814
Mailing address
407 E Cherokee Ave
Enid, OK 73701-5814
Phone (580) 242-7020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100129380A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11370 | OK | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Mary's Physician Associates, LLC | Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268352000000",
"number": "1326154394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 E CHEROKEE AVE",
"city": "ENID",
"state": "OK",
"postal_code": "737015814",
"telephone_number": "580-242-7020",
"fax_number": "580-233-1617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 E CHEROKEE AVE",
"city": "ENID",
"state": "OK",
"postal_code": "737015814",
"telephone_number": "580-242-7020",
"fax_number": "580-233-1617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHRECK",
"first_name": "RONALD",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2010-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OK",
"license": "11370",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100129380A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Enid, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.