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Individual
MR. DAVID SHANNON HADDOCK
Active
Individual
MR. DAVID SHANNON HADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2055
OK
363AS0400X
Surgical Physician Assistant
2005002890
MO
Other
Enumeration date
02/24/2006
Last updated
01/05/2018
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