MEDICARE: DR. GREGG A SHALAN 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	2084N0400X	Neurology Physician	J8126	TX
2	2084A2900X	Neurocritical Care Physician	J8126	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	112880305	OTHER	TX	TPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710979091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG A SHALAN M.D.

Provider Business Mailing Address
First Line	:	221 W COLORADO BLVD STE 525
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2312
Country	:	US
Telephone Number	:	214-956-4525
Fax Number	:	214-960-5681

Provider Business Practice Location Address
First Line	:	221 W COLORADO BLVD STE 525
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2312
Country	:	US
Telephone Number	:	214-956-4525
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	11/04/2022

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Directions to “ DR. GREGG A SHALAN M.D.” Practice Location

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