Provider Demographics
NPI:1184628984
Name:MCNAIR, SHELLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:M
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 MEDICAL DR
Mailing Address - Street 2:STE 310
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6044
Mailing Address - Country:US
Mailing Address - Phone:210-614-8687
Mailing Address - Fax:210-614-7529
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:STE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6044
Practice Address - Country:US
Practice Address - Phone:210-614-8687
Practice Address - Fax:210-614-7529
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83930SOtherBLUE CROSS
TX83930SMedicare ID - Type Unspecified
TX83930SOtherBLUE CROSS