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NPI Code Detail

MEDICARE: DR. JOEL A SHOCKLEY M.D.

MEDICARE: DR. JOEL A SHOCKLEY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician35-07-69147-SOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205801016
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOEL A SHOCKLEY M.D.
Provider Business Mailing Address
First Line : 1331 N ELM ST STE 200
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-6304
Country : US
Telephone Number : 336-274-9617
Fax Number : 336-482-2177
Provider Business Practice Location Address
First Line : 1906 BLAKE AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4227
Country : US
Telephone Number : 970-447-4065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2006
Last Update Date : 04/24/2022

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Directions to “ DR. JOEL A SHOCKLEY M.D.” Practice Location

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