Provider Demographics
NPI:1003947961
Name:COLE, SHANE PARKER (MD)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:PARKER
Last Name:COLE
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 1:714 SUSSEX CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8869
Mailing Address - Country:US
Mailing Address - Phone:809-979-4903
Mailing Address - Fax:682-707-9708
Practice Address - Street 1:801 INTERSTATE 20 W
Practice Address - Street 2:USMD HOSP -- ER DEPT
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5851
Practice Address - Country:US
Practice Address - Phone:817-472-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3571207P00000X
SCLL 29020207P00000X
TXTEMP MED LICENSE207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00834182OtherRR MCARE THRU AEMA
TX204092502Medicaid
P00791718OtherRR MCARE THRU SAEMA
TX204092501Medicaid
TX8BT331OtherBCBS TX
P00834182OtherRR MCARE THRU AEMA
TX204092501Medicaid