Provider Demographics
NPI:1598884645
Name:JOHN P SHEA MD PA
Entity Type:Organization
Organization Name:JOHN P SHEA MD PA
Other - Org Name:SHEA EAR, NOSE & THROAT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-551-1010
Mailing Address - Street 1:11797 SOUTH I-35 W
Mailing Address - Street 2:# 132
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7035
Mailing Address - Country:US
Mailing Address - Phone:817-551-1010
Mailing Address - Fax:817-551-0662
Practice Address - Street 1:11797 SOUTH I-35 W
Practice Address - Street 2:# 132
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7035
Practice Address - Country:US
Practice Address - Phone:817-551-1010
Practice Address - Fax:817-551-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2857207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123528502Medicaid
TXC21698Medicare UPIN
TX123528502Medicaid