Provider Demographics
NPI:1760828586
Name:MATHUR, SHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 FM 1960 BYPASS RD E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3916
Mailing Address - Country:US
Mailing Address - Phone:281-446-7173
Mailing Address - Fax:281-812-2778
Practice Address - Street 1:1702 FM 1960 BYPASS RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3916
Practice Address - Country:US
Practice Address - Phone:281-446-7173
Practice Address - Fax:281-812-2778
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6827208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR6827OtherTEXAS MEDICAL LICENSE