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General NPI Number Information
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NPI Number | 1205801016
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Entity Type | Individual
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Provider Name | JOEL A SHOCKLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 04/24/2022
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Provider Practice Location Address
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Address Line | 1906 BLAKE AVE
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4227
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Country | US
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Telephone | 970-447-4065
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 N ELM ST STE 200
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City | GREENSBORO
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State | NC
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Zip | 27401-6304
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Country | US
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Telephone | 336-274-9617
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Fax | 336-482-2177
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35-07-69147-S
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License Number State | OH
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