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Individual
SHANNON BAGWELL
Active
Individual
SHANNON BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
01061044A
IN
207P00000X
Emergency Medicine Physician
17878
NV
207P00000X
Emergency Medicine Physician
Primary
M5621
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194765263
TRICARE SOUTH
TX
05
—
189042801
—
TX
05
—
189042802
—
TX
01
—
8AK763
BCBSTX
TX
Enumeration date
06/07/2006
Last updated
05/14/2018
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