=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164669545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. SHANNON E. MOREL, DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2009
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 923 BLUE LAKE CIR
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-6912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-206-0698
-----------------------------------------------------
Fax | 469-206-0699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 923 BLUE LAKE CIR
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-6912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-206-0698
-----------------------------------------------------
Fax | 469-206-0699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SHANNON ELIZABETH MOREL
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 469-206-0698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 1577
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------