Provider Demographics
NPI:1629056304
Name:SCHRADER, SHANNON RAY (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAY
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2211 NORFOLK ST
Mailing Address - Street 2:STE 1050
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4044
Mailing Address - Country:US
Mailing Address - Phone:713-526-7736
Mailing Address - Fax:713-524-3155
Practice Address - Street 1:4101 GREENBRIAR ST
Practice Address - Street 2:#200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-5294
Practice Address - Country:US
Practice Address - Phone:713-526-7736
Practice Address - Fax:713-524-3155
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2019-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH8386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1034404OtherCLIA
TX136386304Medicaid
TX8H3095OtherBCBS
TX136386304Medicaid
TX8H3095OtherBCBS