MEDICARE: LARRY GEORGE SHADID M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	H1530	TX

General Provider Information

NPI Number	:	1346355484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY GEORGE SHADID M.D.

Provider Business Mailing Address
First Line	:	2525 WORTHINGTON ST
Second Line	:	#310
City	:	DALLAS
State	:	TX
Zip	:	75204-2556
Country	:	US
Telephone Number	:	214-914-1015
Fax Number	:

Provider Business Practice Location Address
First Line	:	8226 DOUGLAS AVE
Second Line	:	SUITE #805
City	:	DALLAS
State	:	TX
Zip	:	75225-5943
Country	:	US
Telephone Number	:	214-739-1101
Fax Number	:	214-373-3404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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