Provider Demographics
NPI:1508802216
Name:GOODWIN CHAMBERS, SHANNON BETH (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BETH
Last Name:GOODWIN CHAMBERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:BETH
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:580-795-5506
Mailing Address - Fax:
Practice Address - Street 1:500 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-3643
Practice Address - Country:US
Practice Address - Phone:580-795-5506
Practice Address - Fax:580-795-5145
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100097280AMedicaid
OK100097280AMedicaid
TXK1165OtherTMB