Clark, Shannon Michelle

Clark, Shannon Michelle is an individual health care provider with primary practice located at 301 University Blvd , Galveston TX 77555-5302. She recently has only one registered license in Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine, which is considered as her primary health care specialty. Clark, Shannon Michelle can be contacted via phone (409) 772-2222.

Contact Information

Primary practice address
301 University Blvd Galveston TX 77555-5302
Phone: (409) 772-2222
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine 207VM0101X L8653 Texas

Profile Details

NPI number 1568524106
LBN Legal business name Clark, Shannon Michelle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2006
Last updated Jan 28th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568524106 NPPES
Texas MEDICAID 165852801

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