Provider Demographics
NPI:1316365679
Name:ALEXANDER, SHANE CHERIAN (DO)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:CHERIAN
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 WALNUT HILL LN STE 308
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4407
Mailing Address - Country:US
Mailing Address - Phone:214-691-8306
Mailing Address - Fax:214-691-3967
Practice Address - Street 1:8230 WALNUT HILL LN STE 308
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4407
Practice Address - Country:US
Practice Address - Phone:214-691-8306
Practice Address - Fax:214-691-3967
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS2713207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program