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1144204405 NPI number — SHANNON CLAYE WEBB M.D.

NPI Number: 1144204405
Health Care Provider/Practitioner: SHANNON CLAYE WEBB M.D.

Information about “1144204405” NPI (SHANNON CLAYE WEBB M.D.) exists in 1144204405 in HTML format HTML  |  1144204405 in plain Text format TXT  |  1144204405 in PDF (Portable Document Format) PDF  |  1144204405 in an XML format XML  formats.

NPI Number : 1144204405 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144204405",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WEBB",
    "FirstName": "SHANNON",
    "MiddleName": "CLAYE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5818 VILLA LORENZO DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLORADO SPRINGS",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80919-5415",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "864-494-2134",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "IVY CLINIC - BUILDING 7503",
    "SecondLinePracticeLocationAddress": "1650 COCHRANE CIRCLE",
    "PracticeLocationAddressCityName": "FORT CARSON",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80913",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-524-4068",
    "PracticeLocationAddressFaxNumber": "719-526-7132",
    "EnumerationDate": "11/30/2005",
    "LastUpdateDate": "11/20/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "D0091535",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "DR0071691",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "22749",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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