MEDICARE: SHANNON J SCHWAB DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	40982	MN
2	207Q00000X	Family Medicine Physician	Q5925	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	443579YMAF	OTHER	TX	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548245012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON J SCHWAB DO

Provider Business Mailing Address
First Line	:	304 SAVOY ST
Second Line	:
City	:	BULLARD
State	:	TX
Zip	:	75757-5497
Country	:	US
Telephone Number	:	507-380-4784
Fax Number	:

Provider Business Practice Location Address
First Line	:	8288 S BROADWAY AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703
Country	:	US
Telephone Number	:	903-606-7060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	10/01/2019

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Directions to “ SHANNON J SCHWAB DO” Practice Location

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