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Individual
DR. JACKY DWAYNE SHANNON
Active
Individual
DR. JACKY DWAYNE SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
L8505
TX
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
L8505
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L8505
MEDICAL LICENSE
TX
Enumeration date
11/01/2006
Last updated
11/30/2012
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