Provider Demographics
NPI:1194850123
Name:DAVID G. SHULMAN, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID G. SHULMAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:210-821-6901
Mailing Address - Street 1:999 E BASSE RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1801
Mailing Address - Country:US
Mailing Address - Phone:210-821-6901
Mailing Address - Fax:210-821-6941
Practice Address - Street 1:999 E BASSE RD
Practice Address - Street 2:SUITE 127
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1801
Practice Address - Country:US
Practice Address - Phone:210-821-6901
Practice Address - Fax:210-821-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1751207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K63QMedicare ID - Type UnspecifiedGROUP #