Healthcare Provider Details

I. General information

NPI: 1609060383
Provider Name (Legal Business Name): SHRADER FAMILY MEDICAL CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

429 N GUN BARREL LN SUITE 111
GUN BARREL CITY TX
75156-3731
US

IV. Provider business mailing address

429 N. GUN BARREL LANE SUITE 111
GUN BARREL CITY TX
75156
US

V. Phone/Fax

Practice location:
  • Phone: 903-887-2704
  • Fax:
Mailing address:
  • Phone: 903-887-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberG3787
License Number StateTX

VIII. Authorized Official

Name: DR. KAREN E SHRADER
Title or Position: OWNER
Credential: MD
Phone: 903-887-2704