=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316904550
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL J. SHAUGHNESSY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2006
-----------------------------------------------------
Last Update Date | 01/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 FLOYD CURL DR 10TH FLOOR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-575-3817
-----------------------------------------------------
Fax | 210-575-4113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8109 FREDERICKSBURG RD PHYSICIAN PRACTICE SERVICES
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-575-3817
-----------------------------------------------------
Fax | 210-575-4113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | K5002
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------