| Doctor Name: | DR. SHANNON LEE GALLENTINE |
| NPI Number: | 1316957822 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 1513 |
| Business Practice Address: | 150 Eubanks Rd Maypearl, TX - 760641828 |
| Business Phone Number: | 4693839306 |
| Business Fax Number: | 9724352915 |
| Mailing Address: | 150 Eubanks Rd, MAYPEARL |
| State: | TX |
| Postal Code: | 760641828 |
| Phone Number: | 4693839306 |
| Fax Number: | 9724352915 |
| NPI Enumeration Date: | 08/08/2006 |
| NPI Last Update Date: | 05/08/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 1513 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |