Provider Demographics
NPI:1194962027
Name:GEDDES-STOWE, SHANNON M (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:GEDDES-STOWE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3342
Mailing Address - Country:US
Mailing Address - Phone:210-576-5306
Mailing Address - Fax:210-694-0645
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:STE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-576-5306
Practice Address - Fax:210-694-0645
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2024-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN4422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208049102Medicaid
TXB150291OtherWELLMED MEDICAL GROUP PA
TX262798YLUPOtherWELLMED NETWORKS INC
TX208049102Medicaid