1275601577 NPI number — SHANNON E SCOTT PH.D.

Table of content: SHANNON E SCOTT PH.D. (NPI 1275601577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275601577 NPI number — SHANNON E SCOTT PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
SHANNON
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1275601577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11107 WURZBACH RD
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78230-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-697-1866
Provider Business Mailing Address Fax Number:
210-697-1867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11107 WURZBACH RD
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-697-1866
Provider Business Practice Location Address Fax Number:
210-697-1867
Provider Enumeration Date:
12/04/2006

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: 103T00000X , with the licence number:  23728 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 205136900 . This is a "TEXAS WORKER'S COMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 23728 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00D50B . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 032647201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com