Shanna Burris Meads
Dermatologist MOHS-Micrographic Surgeon
1367 Dominion Plz
Tyler
, Texas 75703-1013
Shanna Burris Meads
Dermatologist MOHS-Micrographic Surgeon
1367 Dominion Plz
Tyler
, Texas 75703-1013
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About
Features
Specialties
- Dermatologist
- MOHS-Micrographic Surgeon
Languages spoken
- English
Location
First Address
- Shanna Burris Meads
- 1367 Dominion Plz
- Tyler, TX
- Zip : 75703-1013
- Phone :
Second Address
- Shanna Burris Meads
- 1367 Dominion Plz
- Tyler, TX
- Zip : 75703-1013
- Phone : (903) 534-6200
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Is Shanna Burris Meads a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | M0820 | TX |
| N | 207ND0101X | MOHS-Micrographic Surgeon | M0820 | TX |
National Provider Identifier
| NPI | 1023054624 |
|---|---|
| Provider Name | Shanna Burris Meads |
| First Address | Tyler, TX 75703-1013 |
| Second Address | Tyler, TX 75703-1013 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/06/2006 |
| Last Update Date | 22/05/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 173749601 | (05) | TX |
| 8A2684 | BLUE CROSS AND BLUE SHIELD (01) | TX |
| I27708 | (02) | TX |
| P00228994 | RAILROAD MEDICARE PTAN (01) | TX |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.