Provider Demographics
NPI:1164669545
Name:DR. SHANNON E. MOREL, DPM
Entity Type:Organization
Organization Name:DR. SHANNON E. MOREL, DPM
Other - Org Name:NORTH TEXAS FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MOREL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:469-206-0698
Mailing Address - Street 1:923 BLUE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6912
Mailing Address - Country:US
Mailing Address - Phone:469-206-0698
Mailing Address - Fax:469-206-0699
Practice Address - Street 1:923 BLUE LAKE CIR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-6912
Practice Address - Country:US
Practice Address - Phone:469-206-0698
Practice Address - Fax:469-206-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1577213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6176890001Medicare NSC