Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 2007018123 | MO |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2007018123 | MO |
NPI | 1184814576 |
---|---|
Provider Name | Dr. Shannon Lee Woods |
First Address | Springfield, MO 65807-7310 |
Second Address | Springfield, MO 65807-7310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2007 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184814576 | (05) | MO |
204301303 | (05) | MO |