Provider Demographics
NPI:1073149480
Name:SHANNON KLUPPEL MD
Entity Type:Organization
Organization Name:SHANNON KLUPPEL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-422-5437
Mailing Address - Street 1:1000 E JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-5820
Mailing Address - Country:US
Mailing Address - Phone:281-422-5437
Mailing Address - Fax:281-427-4050
Practice Address - Street 1:1000 E JAMES ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-5820
Practice Address - Country:US
Practice Address - Phone:281-422-5437
Practice Address - Fax:281-427-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114427204Medicaid