Healthcare Provider Details

I. General information

NPI: 1417053208
Provider Name (Legal Business Name): MAXIM E SHUMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PROFESSIONAL PARK
WEBSTER TX
77598
US

IV. Provider business mailing address

16 PROFESSIONAL PARK
WEBSTER TX
77598
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-3503
  • Fax: 281-332-3506
Mailing address:
  • Phone: 281-332-3503
  • Fax: 281-332-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK2769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: