Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | J4075 | TX |
N | 2081P2900X | Pain Medicine | J4075 | TX |
N | 2081S0010X | Sports Medicine | J4075 | TX |
N | 213ES0000X | Sports Medicine | J4075 | TX |
NPI | 1053737403 |
---|---|
Provider Name | Dr. Sandra Dean Shriner |
First Address | Shavano Park, TX 78231-1648 |
Second Address | San Antonio, TX 78231-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2014 |
Last Update Date | 21/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104480203 | (05) | TX |
G33990 | (02) | TX |