Provider Demographics
NPI:1417062639
Name:KLUPPEL, SHANNON EUGENE KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:EUGENE KEITH
Last Name:KLUPPEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8219208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114472701Medicaid