Provider Demographics
NPI:1518918119
Name:COMBS, SHEA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:ELIZABETH
Last Name:COMBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 KINCLAVEN CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2544
Practice Address - Country:US
Practice Address - Phone:979-776-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1385207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174004503Medicaid
TX174004509Medicaid
TX174004501Medicaid
TX174004504Medicaid
TX174004507Medicaid
TX174004508Medicaid
TX8J5093Medicare PIN
TX8D6755Medicare PIN
TX174004509Medicaid
TX174004504Medicaid
TXI33141Medicare UPIN
TXP00428851Medicare PIN
TX8F6591Medicare PIN
TX174004503Medicaid
TXP00235817Medicare PIN
TX8J5088Medicare PIN