Provider Demographics
NPI:1598701393
Name:MANSOUR, EDWARD SHAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SHAWN
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9969
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-6969
Mailing Address - Country:US
Mailing Address - Phone:281-746-3070
Mailing Address - Fax:281-970-5118
Practice Address - Street 1:9201 PINECROFT DR
Practice Address - Street 2:SUITE 295
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3222
Practice Address - Country:US
Practice Address - Phone:281-746-3070
Practice Address - Fax:281-970-5118
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1125207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149831302Medicaid
TX8J0324OtherBLUE CROSS
TXP00036032OtherRAILROAD MEDICARE
TX121037OtherSUPERIOR
TXP00036032OtherRAILROAD MEDICARE
TX8A8478Medicare PIN
TXP00036032Medicare PIN