MEDICARE: LONE STAR EVALUATIONS

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	207Q00000X	Family Medicine Physician	F4272	TX

General Provider Information

NPI Number	:	1619215753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR EVALUATIONS

Provider Business Mailing Address
First Line	:	321 W SAN AUGUSTINE ST
Second Line	:
City	:	DEER PARK
State	:	TX
Zip	:	77536-4027
Country	:	US
Telephone Number	:	281-476-0780
Fax Number	:	281-476-0215

Provider Business Practice Location Address
First Line	:	3717 ROYAL MEADOWS ST
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-6869
Country	:	US
Telephone Number	:	409-722-0600
Fax Number	:	409-724-1928

Authorized Official
Title or Position	:	C.E.O. / PHYSICIAN
Name	:	JERRY M MCSHANE
Credential	:	D.O.
Telephone Number	:	281-476-0780

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	02/28/2014

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Directions to “LONE STAR EVALUATIONS ” Practice Location

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