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General NPI Number Information
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NPI Number | 1194765263
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Entity Type | Individual
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Provider Name | SHANNON BAGWELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 10133 INTERSTATE 10 E
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City | BAYTOWN
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State | TX
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Zip | 77521
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Country | US
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Telephone | 281-576-0555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 725
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City | SPRING
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State | TX
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Zip | 77383-0725
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Country | US
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Telephone | 812-360-5632
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Fax | 281-236-0563
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number | 01061044A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 17878
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M5621
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License Number State | TX
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