Provider Demographics
NPI:1952309973
Name:SHADE, RONNIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:D
Last Name:SHADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7310 S WESTMORELAND RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3002
Mailing Address - Country:US
Mailing Address - Phone:214-337-4700
Mailing Address - Fax:972-709-2847
Practice Address - Street 1:7310 S WESTMORELAND RD STE 1
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2998
Practice Address - Country:US
Practice Address - Phone:214-337-4700
Practice Address - Fax:972-709-2847
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6395207X00000X, 207XS0114X, 207XX0004X, 207XS0106X, 207XX0801X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032574801Medicaid
00CW90OtherMEDICARE ID
472312ZS6WOtherMEDICARE ID
TX032574801Medicaid