NPIMap

Organization Active NPI

Shane E Stidham, MD, PLLC

  • Anesthesiology Physician
  • Norman, OK
National Provider Identifier
1912178872
Registry record updated May 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
22913 Issued in OK
Legal business name
SHANE E STIDHAM, MD, PLLC
Practice address
3650 W Rock Creek Rd
Suite 100
Norman, OK 73072-2202
Phone
(405) 701-3418
Fax
(405) 701-3451
NPI assigned
Mar 19, 2008
Last updated
May 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shane Edward Stidham, M.D.NPI 1083644736
Title
President
Phone
(405) 701-3418

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 22913 OK Primary

Addresses

Primary practice location

3650 W Rock Creek Rd
Suite 100
Norman, OK 73072-2202

Mailing address

3650 W Rock Creek Rd
Suite 100
Norman, OK 73072-2202
Phone (405) 701-3418

Other identifiers 1

IdentifierTypeStateIssuer
200197030AMedicaidOK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304985600000",
    "number": "1912178872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 W ROCK CREEK RD",
            "address_2": "SUITE 100",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730722202",
            "telephone_number": "405-701-3418",
            "fax_number": "405-701-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 W ROCK CREEK RD",
            "address_2": "SUITE 100",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730722202",
            "telephone_number": "405-701-3418",
            "fax_number": "405-701-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE E STIDHAM, MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2011-05-10",
        "status": "A",
        "authorized_official_last_name": "STIDHAM",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-701-3418",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "22913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200197030A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.