Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | Q2769 | TX |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | Q2769 | TX |
NPI | 1497071252 |
---|---|
Provider Name | Shawn Funk |
First Address | San Antonio, TX 78207-3108 |
Second Address | San Antonio, TX 78207-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2010 |
Last Update Date | 09/10/2020 |