Provider Demographics
NPI:1598056293
Name:PURI, SHAWN K (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:K
Last Name:PURI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 208357
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1035
Mailing Address - Country:US
Mailing Address - Phone:512-485-7208
Mailing Address - Fax:844-364-8678
Practice Address - Street 1:4100 DUVAL RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3550
Practice Address - Country:US
Practice Address - Phone:855-876-7246
Practice Address - Fax:855-277-5070
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2023-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXT8315208VP0014X, 208VP0014X
NJ25MA09898100207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2J2738OtherTEXAS MEDICARE
TXT8315OtherTEXAS MEDICAL LICENSE