Provider Demographics
NPI:1245385566
Name:EDWARD T SHIN MD PA
Entity Type:Organization
Organization Name:EDWARD T SHIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-781-0300
Mailing Address - Street 1:PO BOX 262349
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2349
Mailing Address - Country:US
Mailing Address - Phone:972-772-4539
Mailing Address - Fax:972-772-8099
Practice Address - Street 1:5804 COMMUNICATIONS PKWY
Practice Address - Street 2:STE#100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7809
Practice Address - Country:US
Practice Address - Phone:972-772-4539
Practice Address - Fax:972-772-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7179208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6534910001OtherNSC FOR MEDICARE DME
TX00572WMedicare ID - Type Unspecified