Provider Demographics
NPI:1306005798
Name:TAI, SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:TAI
Suffix:
Gender:M
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:PO BOX 731912
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1912
Mailing Address - Country:US
Mailing Address - Phone:903-877-7635
Mailing Address - Fax:903-877-7754
Practice Address - Street 1:115 MEDICAL CIR STE 106
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751
Practice Address - Country:US
Practice Address - Phone:903-675-1322
Practice Address - Fax:903-675-6743
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5044207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-38669OtherBCBS OF AL
AL511-37500OtherBCBS OF AL
AL150833Medicaid
AL151223Medicaid
AL102G70337OtherMEDICARE GROUP PTAN
AL102G70337OtherMEDICARE GROUP PTAN