Provider Demographics
NPI:1598002867
Name:SHAMBURGER, PAUL JOSEPH
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:SHAMBURGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 JOE GOMEZ AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-1803
Mailing Address - Country:US
Mailing Address - Phone:601-447-7749
Mailing Address - Fax:
Practice Address - Street 1:900 MYRTLE AVE
Practice Address - Street 2:APT 1301
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1835
Practice Address - Country:US
Practice Address - Phone:601-447-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00175363A00000X
TXPA08342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty