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Individual

SHANNON K OATES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-8858
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621

Taxonomy

Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01037819A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000180974
ANTHEM PROVIDER NUMBER
IN
05
100095490
IN
01
10825685
CAQH NUMBER
IN
01
9397348
PHCS PID NUMBER
IN
05
OA17622011
IN
Enumeration date
03/20/2006
Last updated
02/03/2021
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