Healthcare Provider Details

I. General information

NPI: 1184814576
Provider Name (Legal Business Name): SHANNON LEE WOODS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

3555 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3800
  • Fax: 417-875-3809
Mailing address:
  • Phone: 417-875-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2007018123
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2007018123
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: