Healthcare Provider Details

I. General information

NPI: 1003093253
Provider Name (Legal Business Name): YEVGENY SHUHATOVICH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W MEDICAL CENTER BLVD # 404
WEBSTER TX
77598-4009
US

IV. Provider business mailing address

PO BOX 58538
WEBSTER TX
77598-8538
US

V. Phone/Fax

Practice location:
  • Phone: 281-985-9342
  • Fax: 281-393-0029
Mailing address:
  • Phone: 281-985-9342
  • Fax: 281-393-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberP4713
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP4713
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberP4713
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: