MEDICARE: DR. RONNIE D SHADE 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	207X00000X	Orthopaedic Surgery Physician	G6395	TX
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	G6395	TX
3	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	G6395	TX
4	207XS0106X	Orthopaedic Hand Surgery Physician	G6395	TX
5	207XX0801X	Orthopaedic Trauma Physician	G6395	TX
6	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	G6395	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00CW90	OTHER		MEDICARE ID
3	472312ZS6W	OTHER		MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952309973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONNIE D SHADE M.D.

Provider Business Mailing Address
First Line	:	7310 S WESTMORELAND RD STE 1
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3002
Country	:	US
Telephone Number	:	214-337-4700
Fax Number	:	972-709-2847

Provider Business Practice Location Address
First Line	:	7310 S WESTMORELAND RD STE 1
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2998
Country	:	US
Telephone Number	:	214-337-4700
Fax Number	:	972-709-2847

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	11/29/2016

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Directions to “ DR. RONNIE D SHADE M.D.” Practice Location

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