Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | P9733 | TX |
N | 207PP0204X | Pediatric Emergency Physician | P9733 | TX |
NPI | 1437441219 |
---|---|
Provider Name | Dr. Courtney Michelle Shockley |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 21/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
372620001 | (05) | TX |
372620002 | CSHCN (01) | TX |