Provider Demographics
NPI:1043292493
Name:FAUBION, SHELLY DAWN (DO)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:DAWN
Last Name:FAUBION
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6668
Mailing Address - Fax:405-701-6170
Practice Address - Street 1:303 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6709
Practice Address - Country:US
Practice Address - Phone:405-794-4664
Practice Address - Fax:405-794-2853
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3260207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125330BMedicaid
OK100125330BMedicaid
OK242623501Medicare PIN
OKOK401088Medicare PIN
OKP00700436Medicare PIN