Provider Demographics
NPI:1902032162
Name:YORK, SHAUN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:MICHAEL
Last Name:YORK
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7666207P00000X, 207Q00000X
TXBP10035372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-048OtherTRICARE
TX75-0818167-015OtherTRICARE
TX283376614Medicaid
TX75-2616977-001OtherTGRICARE
TX75-2616977-028OtherTRICARE
TX283376613Medicaid
TX283376615Medicaid
TX75-0818167-022OtherTRICARE
TX75-2616977-002OtherTRICARE
TX283376616Medicaid
TX75-1976930-005OtherTRICARE
TX75-0818167-044OtherTRICARE
TX273014YS6VMedicare PIN
TX75-0818167-048OtherTRICARE
TX283376613Medicaid
TX75-0818167-022OtherTRICARE