Provider Demographics
NPI:1295916583
Name:ALWOOD, SHANNON M (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:ALWOOD
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 1:3117 TWELVE OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-5728
Mailing Address - Country:US
Mailing Address - Phone:504-481-2289
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAVIER ST
Practice Address - Street 2:7TH FLOOR, STE D
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2272
Practice Address - Country:US
Practice Address - Phone:504-903-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200662207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073491Medicaid
LAP00650196OtherRAILROAD MCARE THRU PEPA
LA1073491Medicaid
LA1073491Medicaid