Healthcare Provider Details

I. General information

NPI: 1871941237
Provider Name (Legal Business Name): MARY SHIPMAN D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY NEWMAN

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7556 HONEYSUCKLE
TEMPLE TX
76502-5631
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-742-7400
  • Fax: 254-742-7407
Mailing address:
  • Phone: 254-724-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4323
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: