Provider Demographics
NPI:1144510223
Name:JUNG-PETERS, SHAUN S (DO)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:S
Last Name:JUNG-PETERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SHAUN
Other - Middle Name:S
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1717 S UTICA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5346
Mailing Address - Country:US
Mailing Address - Phone:918-748-1300
Mailing Address - Fax:918-748-1303
Practice Address - Street 1:1717 S UTICA AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5346
Practice Address - Country:US
Practice Address - Phone:918-748-1300
Practice Address - Fax:918-748-1303
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine