Provider Demographics
NPI:1205820404
Name:SHIMER, TRICIA A (MDPA)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:A
Last Name:SHIMER
Suffix:
Gender:F
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 WALNUT HILL LN
Mailing Address - Street 2:SUITE LL001
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4339
Mailing Address - Country:US
Mailing Address - Phone:469-364-3760
Mailing Address - Fax:469-364-3767
Practice Address - Street 1:8160 WALNUT HILL LN
Practice Address - Street 2:SUITE LL001
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4339
Practice Address - Country:US
Practice Address - Phone:469-364-3760
Practice Address - Fax:469-364-3767
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2006207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160267401Medicaid
TXH43349Medicare UPIN
TX160267401Medicaid