Provider Demographics
NPI:1790011815
Name:COMBS, SHANNA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:MARIE
Last Name:COMBS
Suffix:
Gender:F
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:6210 JOHN RYAN DR STE 104
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4111
Practice Address - Country:US
Practice Address - Phone:817-294-7578
Practice Address - Fax:817-294-0585
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3572207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DF835OtherBCBS
TX298000501Medicaid
TXP01105603OtherRAILROAD MEDICARE
TX298000501Medicaid