Healthcare Provider Details

I. General information

NPI: 1457464356
Provider Name (Legal Business Name): ALAN DALE SHILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 S LOOP 256
PALESTINE TX
75801-6977
US

IV. Provider business mailing address

3323 S LOOP 256
PALESTINE TX
75801-6977
US

V. Phone/Fax

Practice location:
  • Phone: 903-723-1010
  • Fax: 903-723-0314
Mailing address:
  • Phone: 903-723-1010
  • Fax: 903-723-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberH8398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: