Provider Demographics
NPI:1891734968
Name:SHALLIN, ANTHONY W (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:W
Last Name:SHALLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:SHALLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3613 WILLIAMS DR
Mailing Address - Street 2:STE 404
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1377
Mailing Address - Country:US
Mailing Address - Phone:512-930-4275
Mailing Address - Fax:512-930-4093
Practice Address - Street 1:3613 WILLIAMS DR
Practice Address - Street 2:STE 404
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1377
Practice Address - Country:US
Practice Address - Phone:512-930-4275
Practice Address - Fax:512-930-4093
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF80299Medicare UPIN
TX00435YMedicare ID - Type UnspecifiedMEDICARE #