Healthcare Provider Details

I. General information

NPI: 1215101159
Provider Name (Legal Business Name): PTMD LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5826 ESPLANADE DR STE 202C
CORPUS CHRISTI TX
78414-4198
US

IV. Provider business mailing address

PO BOX 271356
CORPUS CHRISTI TX
78427-1356
US

V. Phone/Fax

Practice location:
  • Phone: 361-442-7740
  • Fax: 361-232-5695
Mailing address:
  • Phone: 361-442-7740
  • Fax: 361-232-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE SHAHEEN
Title or Position: PRESIDENT
Credential:
Phone: 361-288-1855