Individual
VICKIE R. SHANNON
Active
Individual
VICKIE R. SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
G7762
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103260901
—
TX
01
—
110064818
RR MEDICARE
TX
01
—
82M149
BCBS
TX
Enumeration date
10/05/2006
Last updated
06/29/2012
Update your record
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