Provider Demographics
NPI:1346262870
Name:SHIRES, GEORGE THOMAS III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:SHIRES
Suffix:III
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 1:8230 WALNUT HILL LN STE 320
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4481
Mailing Address - Country:US
Mailing Address - Phone:214-369-5432
Mailing Address - Fax:214-369-5591
Practice Address - Street 1:8230 WALNUT HILL LN STE 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4481
Practice Address - Country:US
Practice Address - Phone:214-369-5432
Practice Address - Fax:214-369-5591
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9420208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8649J2Medicare PIN
TX492794YKQLMedicare PIN
TXA64609Medicare UPIN