Provider Demographics
NPI:1003085176
Name:EDIE E. SHULMAN M.D., PLLC
Entity Type:Organization
Organization Name:EDIE E. SHULMAN M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-339-1535
Mailing Address - Street 1:11673 JOLLYVILLE RD.
Mailing Address - Street 2:SUITE B-101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4200
Mailing Address - Country:US
Mailing Address - Phone:512-339-1535
Mailing Address - Fax:512-339-1526
Practice Address - Street 1:11673 JOLLYVILLE RD.
Practice Address - Street 2:SUITE B-101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4200
Practice Address - Country:US
Practice Address - Phone:512-339-1535
Practice Address - Fax:512-339-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty