Healthcare Provider Details

I. General information

NPI: 1164400487
Provider Name (Legal Business Name): SHAWN MERILL VARNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR DEPARTMENT OF EMERGENCY MEDICINE
SAN ANTONIO TX
78234-4501
US

IV. Provider business mailing address

515 RUIDOSA DOWNS
HELOTES TX
78023-4609
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-5512
  • Fax:
Mailing address:
  • Phone: 210-888-4951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0056446
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberP3678
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: