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General NPI Number Information
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NPI Number | 1649299710
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Entity Type | Individual
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Provider Name | SHAUN MICHAEL SHORE PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 960 CARIBOU DR
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City | PROSPER
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State | TX
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Zip | 75078-7066
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Country | US
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Telephone | 469-343-6333
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Fax | 855-299-6441
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Provider Business Mailing Address
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Address Line | 960 CARIBOU DR
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City | PROSPER
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State | TX
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Zip | 75078-7066
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Country | US
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Telephone | 469-343-6333
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Fax | 855-299-6441
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA04445
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License Number State | TX
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