=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699002774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID S SHELMIRE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2009
-----------------------------------------------------
Last Update Date | 11/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8226 DOUGLAS AVE SUITE 549
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-5943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-750-0504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8226 DOUGLAS AVE SUITE 549
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-5943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-750-0504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID S SHELMIRE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-750-0501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | C9322
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------