Healthcare Provider Details

I. General information

NPI: 1043646730
Provider Name (Legal Business Name): SHANON G SCHWIMMER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 TRAVIS ST SUITE 210
DALLAS TX
75204-1465
US

IV. Provider business mailing address

PO BOX 141023
DALLAS TX
75214-1023
US

V. Phone/Fax

Practice location:
  • Phone: 214-522-0210
  • Fax: 214-522-0474
Mailing address:
  • Phone: 214-522-0210
  • Fax: 214-522-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL0577
License Number StateTX

VIII. Authorized Official

Name: SHANON GERVAISE SCHWIMMER
Title or Position: PRESIDENT
Credential: MD
Phone: 214-522-0210