Healthcare Provider Details

I. General information

NPI: 1104883206
Provider Name (Legal Business Name): SHU SHUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HALSTEAD ST
AMARILLO TX
79106-1830
US

IV. Provider business mailing address

1801 HALSTEAD ST
AMARILLO TX
79106-1811
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-8526
  • Fax: 806-358-0179
Mailing address:
  • Phone: 806-358-8526
  • Fax: 806-358-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF7915
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: