DR. SHANE BLAKE ANDERSON (NPI# 1144208661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144208661 |
| Entity Type | Individual |
| Full Name | DR. SHANE BLAKE ANDERSON |
| Credential | D.O. |
| Practice Address |
3551 Roger Brooke Dr Brooke Army Medical Center Fort Sam Houston TX 78234-4504 |
| Mailing Address |
3551 Roger Brooke Dr Brooke Army Medical Center Fort Sam Houston TX 78234 |
| Practice Telephone | 2109164062 |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2014-05-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207UN0902X |
Nuclear Medicine Specialization: Nuclear Imaging & Therapy |
378 | NE | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
378 | NE | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295168433 | Shane Robert Anderson | Otolaryngology | 1106 Beechwood St, Hillcrest, Little Rock, AR 72205 | 2013-08-12 |
| 1750513040 | Shane Michael Anderson | Counselor | 1643 Sr 104, Chillicothe, OH 45601 | 2009-08-20 |
| 1841289659 | Shane Keith Anderson | Internal Medicine | 220 Bannock St, Malad City, ID 83252-1256 | 2005-10-14 |
| 1952863946 | Shane Corbin Anderson | Student in an Organized Health Care Education/Training Program | 462 Grider St, Buffalo, NY 14215-3021 | 2019-04-01 |
| 1720523418 | Shane David Anderson | Nurse Practitioner | 6316 Old Oak Ridge Rd, Greensboro, NC 27410-9939 | 2017-01-04 |
| 1497002299 | Shane S Anderson | Pharmacist | 1502 N Vercler Rd, Spokane Valley, WA 99216 | 2012-08-10 |
| 1639461635 | Shane M Anderson | Pharmacist | 402 S 4th Ave, Yakima, WA 98902-3546 | 2011-05-09 |
| 1952383432 | Shane Selassie Anderson | Pathology | 1001 Sw Klickitat Way, 205, Seattle, WA 98134-1161 | 2005-11-18 |
| Street Address |
3551 ROGER BROOKE DR BROOKE ARMY MEDICAL CENTER |
| City | FORT SAM HOUSTON |
| State | TX |
| Zip Code | 78234-4504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861093338 | Aneesh N/a Benoy | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-11-02 |
| 1164021580 | William Edward Vick | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-19 |
| 1548868003 | Julia D Coffey | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-15 |
| 1801493465 | Emiri Elliott | Registered Nurse | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-07 |
| 1437756574 | Clarence Michael Sullivan | Military Health Care Provider | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-01 |
| 1093320350 | Natalie Marie Greene | Physical Therapist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-09-14 |
| 1033722509 | Kody Vallejo | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-25 |
| 1558972620 | Renee Therese Hart | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-12 |
| 1235749722 | Emily Ann Robinson | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-09 |
| 1902415367 | Hannah Daniel | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255942884 | Thomas Ballas | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa-fort Sam Houston, Department of Behavioral Medicine-mche-dbm, San Antonio, TX 78234 | 2020-08-17 |
| 1124657366 | Wendy Harris | Pharmacist | 3041 Garden Ave, Fort Sam Houston, TX 78234 | 2020-04-08 |
| 1215564729 | Travis Frantz | Student in an Organized Health Care Education/Training Program | 3551 Rodger Brooke Drive, Jbsa Fort Sam Houston, TX 78234 | 2020-03-25 |
| 1508492695 | Matthew Grossmann | Student in an Organized Health Care Education/Training Program | San Antonio Military Medical Center, Mche-zdm-m, Internal Medicine Residency, 3551 Roger Brooke Dr., Jbsa-fort Sam Houston, TX 78234 | 2020-03-20 |
| 1235793407 | Jessica Maria May Franklin | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa Fort Sam Houston, San Antonio, TX 78234 | 2019-04-23 |
| 1730663477 | Glen Snyder | Military Health Care Provider | 3488 Garden Ave Anderson Hall, Fort Sam Houston, San Antonio, TX 78234 | 2018-09-19 |
| 1265919336 | Ashley Elizabeth Malawey | Military Health Care Provider | 3222 Cpl Johnson Road, San Antonio, TX 78234 | 2018-07-23 |
| 1053805515 | Rene Espinosa | Social Worker | San Antonio Medical Center, 3551 Roger Brooke Dr, Jbsa, TX 78234 | 2018-06-19 |
| 1235622333 | Melanie Edith Rivera | Military Health Care Provider | 3600 Roger Brooke Drive, San Antonio, TX 78234 | 2018-06-13 |
| 1063909158 | Benjamin Walker Appelo | General Practice | San Antonio Mil Med Center 3551 Roger Brooke Dr, Mche-zdm-m, San Antonio, TX 78234 | 2018-04-16 |
| Find all providers in zip 78234 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114157740 | Aaron Jackson | Radiology | Bamc- 3851 Roger Brooke Drive, Mche-qd, Fort Sam Houston, TX 78234-6200 | 2009-07-16 |
| 1982066585 | Jason Shore | Radiology | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2016-03-23 |
| 1750773297 | Brooke Marie Bell | Radiology | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2015-02-20 |
| 1952725707 | Joshua Kuroiwa | Radiology | 3551 Roger Brooke Dr, Mche/me, Fort Sam Houston, TX 78234-4504 | 2014-02-14 |
| 1265706097 | Timothy Ba Dinh | Radiology | 3551 Roger Brooke Drive, Mche/me, Fort Sam Houston, TX 78234 | 2012-02-24 |
| 1255659389 | Norman J Arbelo Cruz | Radiology | 3851 Roger Brooke Dr, Diagnostic Radiology, Fort Sam Houston, TX 78234-4501 | 2010-05-13 |
| 1417117268 | Steven Hoyt Craig | Radiology | 3851 Roger Brooke Dr, Mche-qd (creds), Fort Sam Houston, TX 78234-4501 | 2008-06-16 |
| 1205976214 | Lisa M. Livingston | Radiology | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2007-02-07 |
| 1669431227 | Penny Jean Vroman | Radiology | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2006-03-22 |
| 1467423442 | Sompong Nmn Singshinsuk | Radiology | 3851 Roger Brooke Dr, Bamc Mche- Qd ( Creds ), Fort Sam Houston, TX 78234-4501 | 2006-01-30 |
| Find all providers in FORT SAM HOUSTON | ||||
| City | FORT SAM HOUSTON |
| Zip Code | 78234 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.