Provider Demographics
NPI:1477746204
Name:SHALEN, PHILIP ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ROGER
Last Name:SHALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3060 COMMUNICATIONS PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8449
Mailing Address - Country:US
Mailing Address - Phone:972-312-9944
Mailing Address - Fax:
Practice Address - Street 1:3060 COMMUNICATIONS PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8449
Practice Address - Country:US
Practice Address - Phone:972-312-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF61092085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
B26375 30 TX 75238Medicare UPIN