Healthcare Provider Details

I. General information

NPI: 1942431341
Provider Name (Legal Business Name): SHAE BRYAN PASCHAL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 S CENTER ST SUITE 140
ARLINGTON TX
76014-2022
US

IV. Provider business mailing address

3050 S CENTER ST SUITE 140
ARLINGTON TX
76014-2022
US

V. Phone/Fax

Practice location:
  • Phone: 817-557-1006
  • Fax: 817-557-2000
Mailing address:
  • Phone: 817-557-1006
  • Fax: 817-557-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number9537
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1904
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: