Healthcare Provider Details

I. General information

NPI: 1508802216
Provider Name (Legal Business Name): SHANNON BETH GOODWIN CHAMBERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON BETH GOODWIN

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BROOKSIDE DR
MADILL OK
73446-3643
US

IV. Provider business mailing address

5012 S US HIGHWAY 75 STE 300 ATTN BILLING
DENISON TX
75020-4589
US

V. Phone/Fax

Practice location:
  • Phone: 580-795-5506
  • Fax: 580-795-5145
Mailing address:
  • Phone: 580-795-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20525
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: