1437360385 NPI number — SHANNON ELIZABETH MCCANTS MD

Table of content: SHANNON ELIZABETH MCCANTS MD (NPI 1437360385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437360385 NPI number — SHANNON ELIZABETH MCCANTS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCANTS
Provider First Name:
SHANNON
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1437360385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 GASTON AVENUE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-824-3200
Provider Business Mailing Address Fax Number:
214-461-9421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 REPUBLIC PKWY
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150-6918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-613-6336
Provider Business Practice Location Address Fax Number:
214-461-9423
Provider Enumeration Date:
05/24/2007

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: 207V00000X , with the licence number:  N1759 , 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)





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