Provider Demographics
NPI:1356387351
Name:CULLEN, SHAWN PAUL (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:PAUL
Last Name:CULLEN
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:2006-06-20
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114148207P00000X
TXN3586207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204771401Medicaid
TX1356387351OtherBCBS
TX204771402Medicaid
TX750818167-044OtherTRICARE
TX751976930-005OtherTRICARE
TXP00738378OtherMEDICARE RAILROAD
TX750818167-015OtherTRICARE
TXP00739413OtherMEDICARE RAILROAD
TX204771401Medicaid
TX8L17649Medicare Oscar/Certification