Provider Demographics
NPI:1326050832
Name:MACDONALD, SHAWN BRYDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:BRYDEN
Last Name:MACDONALD
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 1:2500 N TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2521
Mailing Address - Country:US
Mailing Address - Phone:903-868-8900
Mailing Address - Fax:903-868-8990
Practice Address - Street 1:2500 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2521
Practice Address - Country:US
Practice Address - Phone:903-868-8900
Practice Address - Fax:903-868-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75-2548578261QU0200X
TXG6559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18647Medicare UPIN
TX863122Medicare PIN