1184700221 NPI number — MR. SHON DAVID COMPTON PHYSICIAN ASSISTANT

Table of content: MR. SHON DAVID COMPTON PHYSICIAN ASSISTANT (NPI 1184700221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184700221 NPI number — MR. SHON DAVID COMPTON PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMPTON
Provider First Name:
SHON
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184700221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 CORSICA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIBOLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78108-4249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-566-6941
Provider Business Mailing Address Fax Number:
210-221-5772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GARDEN AVE
Provider Second Line Business Practice Location Address:
MCWETHY TROOP MEDICAL CLINIC, BROOK ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
FT. SAM HOUSTON, SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-295-4958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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