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General NPI Number Information
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NPI Number | 1770874240
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Entity Type | Organization
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Legal Business Name | SHAUN A MCMURTRY MD PLLC
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 2303 IRA E WOODS AVE
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City | GRAPEVINE
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State | TX
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Zip | 76051-3926
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Country | US
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Telephone | 817-416-1016
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Fax | 817-416-1019
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Provider Business Mailing Address
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Address Line | 2303 IRA E WOODS AVE
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City | GRAPEVINE
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State | TX
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Zip | 76051-3926
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Country | US
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Telephone | 817-416-1016
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Fax | 817-416-1019
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAUN MCMURTRY
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Credential | M.D.
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Telephone | 214-934-2330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | N0265
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License Number State | TX
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