Individual
EDDIE G SHELL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 E BEAUREGARD AVE, SAN ANGELO, TX 76903-5919
(325) 658-1511
Mailing address
120 E BEAUREGARD AVE, SAN ANGELO, TX 76903-5919
(325) 374-1436
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L0593
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151500905
—
TX
05
—
151500906
—
TX
01
—
8M1836
BCBS
TX
01
—
8M2152
BCBS
TX
01
—
P00146117
MEDICARE RAILROAD
TX
01
—
P00306677
MEDICARE RAILROAD
TX
Enumeration date
12/29/2005
Last updated
01/16/2019
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