Provider Demographics
NPI:1265420699
Name:PANZER, SHAWN W (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:W
Last Name:PANZER
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 1:2501 SCRIPTURE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2313
Mailing Address - Country:US
Mailing Address - Phone:940-566-4720
Mailing Address - Fax:940-566-4727
Practice Address - Street 1:2501 SCRIPTURE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2313
Practice Address - Country:US
Practice Address - Phone:940-566-4720
Practice Address - Fax:940-566-4727
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16751207RG0100X
TXJ0784207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BX640OtherBCBS
TX129377106Medicaid
MS00122103Medicaid
TX8BX640OtherBCBS
TX129377106Medicaid
TX8F20758Medicare PIN
MS00122103Medicaid